Treating Obesity to Prevent Diabetes

Twenty years ago in the New England Journal of Medicine, the Diabetes Prevention Program showed that intensive lifestyle coaching for weight control can cut the risk of diabetes for people with prediabetes by 58 percent over a period of three years. At the upcoming EASD meeting, Tim Garvey and colleagues will present an analysis 10-year risk scores to show that treating obesity with semaglutide 2.4 mg might prevent type-2 diabetes from emerging. In fact, it cut the 10-year risk for developing type-2 diabetes by 61 percent in their study.

For reference, the 10-year follow-up from the DPP found a 34 percent reduction in diabetes incidence after the lifestyle coaching.

A Post-Hoc Analysis

Garvey et al analyzed data from the Step 1 and Step 4 studies of semaglutide for obesity. They used the Cardiometabolic Disease Staging tool to calculate 10-year diabetes risk scores. The results are striking, as Garvey explains:

“Semaglutide reduces the future risk of diabetes by over 60% in patients with obesity. This figure is similar whether a patient has prediabetes or normal blood sugar levels. Sustained treatment is required to maintain the benefit.

“Given the rising rates of obesity and diabetes, semaglutide could be used effectively to reduce the burden of these chronic diseases.”

In a similar vein, data from the STEP-5 study shows a 59% rate of remission from metabolic syndrome with semaglutide treatment. Rachel Batterham and colleagues say that this shows promise for preventing diabetes and cardiovascular disease. But they are quick to caution that theirs is a small study.

So the real test will come from prospective studies of major adverse cardiometabolic outcomes.

Preventing Diabetes with Drugs That also Treat Diabetes

These data give us something to puzzle over. Intensive lifestyle coaching can forestall the development of diabetes in people with obesity. Bariatric surgery is even more effective for this. But now it seems that another strategy might be to employ a new generation of drugs for obesity to do the same thing.

But semaglutide is a dual-duty drug. It works to control diabetes as well as to treat obesity. So if someone is taking an obesity/diabetes med in hopes of preventing diabetes, it’s worth asking what the net benefit might be.

And that brings us back to major adverse outcomes over the long term. This means heart attacks, strokes, and death. Clearly, bariatric surgery can deliver a reduction in these bad outcomes. The Look AHEAD study told us that lifestyle coaching for weight loss does not.

So the next question becomes can treating obesity with new generation of more effective meds not only prevent diabetes, but also prevent major bad outcomes?

The data will tell the story.

Click here for the meeting abstracts from the EASD meeting. The Batterham abstract is #498 and the Garvey abstract is #562. For more on this news, click here and here.

Station Without a Stop, painting by Kazimir Malevich / WikiArt

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September 16, 2022