Experts join forces to learn more about link between obesity, type 2 diabetes

Issue: November 2011

EASD 47th Annual Meeting

LISBON — The European Association for the Study of Diabetes, American Diabetes Association and the Endocrine Society are working together to improve understanding of how obesity relates to type 2 diabetes to help advance effective and cost-effective interventions for both conditions.

“This is the largest public health problem that we will be grappling with worldwide for the next 100 years. It is growing more rapidly than [other issues] and causes an enormous amount of premature death and morbidity,” David M. Nathan, MD, of the Diabetes Center at Massachusetts General Hospital and Harvard Medical School, said at a press conference. “Yet, our understanding of the fine points of how obesity and diabetes interact is relatively simplistic. We understand something about it, but not a lot.”

David M. Nathan, MD

To further the understanding of the relationship between obesity and diabetes, experts from the various associations met in January. The working group comprised 32 experts in the areas of pathophysiology, genetics, clinical trials and clinical care of obesity and/or type 2 diabetes. The review examined published literature and unpublished data to reach consensus on future needs in the research and clinical care of obesity and type 2 diabetes.

Questions identified

As a result of the meeting, four major questions regarding this relationship were identified. The experts declared that these areas should be tackled using combined basic, clinical and population-based scientific approaches.

Why is it that all people who develop obesity do not develop type 2 diabetes?
What are the mechanisms responsible for obesity and insulin resistance to result in beta cell decompensation and, if and when obesity prevention ensues, will we expect to see a reduction in the incidence of type 2 diabetes?
How does the length of time an individual has had type 2 diabetes relate to the benefits of weight reduction by lifestyle, weight loss drugs and/or bariatric surgery and the effects on beta cell function and glucose control?
What is necessary for regulatory approval of medications and possibly surgical approaches for the prevention of type 2 diabetes in obesity?

“First, one really needs to elucidate better the pathogenesis that links the problem of obesity to type 2 diabetes, expand research on the heterogeneity of these diseases and develop innovative approaches to pharmaco and surgical management that would better allow us to treat these diseases,” Steven E. Kahn, MB, ChB, professor of medicine in the division of metabolism, endocrinology and nutrition at VA Puget Sound Health Care System and University of Washington School of Medicine, said here. He argued for a “world effort” to emphasize primary prevention of obesity and type 2 diabetes.

Kahn said numerous studies have shown that it is possible to prevent type 2 diabetes with either lifestyle intervention or medication. However, "these studies all show that you cannot prevent it in everybody." He suggested adoption of a chronic disease model linking obesity to diabetes care..

The last question about regulatory approval of medications and surgical approaches for prevention resulted from the struggles of encouraging regulatory organizations to go forward and make rules for what is needed to prevent diabetes, according to Kahn. “For example, with medications in the US, the Diabetes Prevention Program has clearly shown the benefits of metformin yet most countries do not approve it as an indication for this drug,” he said.

Moving forward

The results of this meeting have created “momentum going forward, in terms of needs for additional research,” Robert H. Eckel, MD, professor of medicine, physiology and biophysics and Charles A. Boettcher Endowed Chair in Atherosclerosis at the University of Colorado School of Medicine, told Endocrine Today.

"Ultimately, in the future, there will be other topics of much-needed science," Eckel said. One such topic may be adressing the role of inflammation in the relationship between obesity and type 2 diabetes. "It could be, perhaps, how classic hormones impact intermediary metabolism or other topics that would assemble though leaders from around the world to bring us up to date on the science, but also to identify areas where RFAs (Requests For Applications) could be identified for additional research. That's the purpose of this and, ultimately, this will ensue as a joint venture between the ADA, the Endocrine Society and the EASD."

The recommendations made as a result of the meeting were published in June in both Diabetes Care and the Journal of Clinical Endocrinology and Metabolism. – by Stacey L. Fisher

Disclosures: Drs. Eckel, Kahn and Nathan report no relevant financial disclosures.

For more information:

Kahn SE. Overview of obesity and type 2 diabetes.

Eckel RH. Pathogenesis.

Nathan DM. Treatment. EASD/ADA Symposium: Obesity and type 2 diabetes: What's similar and what's different? Presented at: The European Association for the Study of Diabetes 47th Annual Meeting; Sept. 12-16, 2011; Lisbon.

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