Tying Obesity and Type 2 Diabetes Closer Together

Understanding the chronic disease of obesity is growing clearer. As this understanding grows, we’re seeing the tie between obesity and type 2 diabetes grow closer. Of course, the overlap of these two diseases is not 100 percent, but it is considerable. Two notable papers this week serve to illustrate.

One explains more fully how fat cells interact with insulin to produce inflammation, type 2 diabetes, and other chronic diseases. Then the other paper explains why obesity care should be a primary treatment goal for treating type 2 diabetes.

How Fat Cells Enlarge and Age

Maria Kutschke and colleagues from the Karolinska Institute published their work in Nature Medicine Monday. For the first time, they have shown that senescent (aging) fat cells (adipocytes) drive the process that leads to all of the systemic inflammation that goes with obesity. Chronic, excessive levels of insulin secretion play a role in activating this aging of fat cells, which in turn activates inflammation.

They also show that metformin can block the formation of these senescent fat cells and thus prevent some of that inflammation. Senior author Kirsty Spalding explains the significance:

“These studies identify an unappreciated aspect of human adipocyte biology, the activation of a cell cycle program in obesity and hyperinsulinemia, which could pave the way for novel treatment strategies for obesity and associated co-morbidities, such as type 2 diabetes.”

Obesity and Diabetes Care Go Together

Writing in Lancet, Ildiko Lingvay, Priya Sumithran, Ricardo  Cohen, and Carel le Roux tell us that obesity and diabetes care should go hand in hand. This is because weight loss of 15 percent can actually alter the course of type 2 diabetes. But there’s a big challenge here, says Lingvay:

“Our main message is that treatment of obesity should be the future of diabetes treatment.

“Right now, a relatively small percentage of clinicians address obesity and know how to treat it. That has to change. Every clinician who treats diabetes needs to know how to treat obesity.”

Already, we are headed in the right direction. A little more than a decade ago, many of the top-selling drugs for type 2 diabetes actually caused weight gain. Avandia was a prime example. But it and others like it have fallen out of favor. Now the leading drugs for treating diabetes can actually bring weight loss. Two of them – liraglutide and semaglutide – can also be safe and effective for treating obesity. Doctors are now using insulin more carefully to avoid causing weight gain.

So we’re on the way. But despite all the gain in understanding obesity, it is a messy subject. People bring bias to the subject and that leads to mistakes. Knowledge can overcome bias over time, though. This is what gives us hope for better outcomes.

Click here for the study in Nature Medicine, and here for further perspective. For the paper by Linvay et al, click here. You can find further reporting here and here.

Dinner, painting by Franz Stuck / WikiArt

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October 6, 2021

One Response to “Tying Obesity and Type 2 Diabetes Closer Together”

  1. October 06, 2021 at 7:11 am, Allen Browne said:

    “Knowledge can overcome bias over time, though.” But it is sure long and painful sometimes. But the knowledge is there and needs to be disseminated.