Is diabetes all about weight management?
Mention diabetes and it’s not long before the subject of weight management is raised. In fact, the link between diabetes and weight is so prevalent that one of the major online research publishers, Wiley, regularly publishes a journal entitled ‘diabetes, obesity and metabolism.’
So, noting that Wiley brings metabolism into the equation, is diabetes all about weight management or should we be looking elsewhere for solutions to the growing diabetic crisis?
Well, let’s start by acknowledging that not all diabetes is the same. Type 1 diabetes, which accounts for some 8% of all diabetes cases in the UK, occurs when the body attacks the pancreas. As a result, the pancreas is unable to produce insulin which is needed to enable glucose to move from the blood into cells across the body.
Scientists are still working on identifying the trigger mechanism for Type 1 diabetes but, according to Diabetes UK, Type 1 diabetes is not caused by diet or lifestyle.
Having said that, a healthy balanced diet can help with blood sugar levels, making it easier to manage the condition on a daily basis.
A healthy balanced diet can also help with gestational diabetes which occurs in some 4% of pregnancies. Gestational diabetes tends to reverse following birth. However, those who develop gestational diabetes are at greater risk of going on to develop Type 2 diabetes, as are children born from gestational diabetes sufferers.
Type 2 diabetes is the most common form of diabetes, accounting for some 90% of all cases.
With obesity being one of the prime risk factors for Type 2 diabetes, it is hardly surprising that weight management is regularly seen as being inextricably linked with diabetes. And indeed, we have reported elsewhere on the way in which a reduction in weight can either help to prevent diabetes from developing or can in some cases result in the diabetes going into remission.
For example, the NHS diabetes prevention programme resulted in a seven per cent reduction in the number of new diabetes cases between 2018 and 2019, helping to prevent some 18,000 people from going on to develop the condition. The nine-month programme provides personalised support and advice in losing weight, eating more healthily and becoming more active.
Here then is the first clue that managing diabetes is not solely about weight management. Admittedly, eating a balanced diet and taking more exercise can help with weight management; but it also benefits the body in other ways, helping to reset metabolisms and reduce the chance of developing secondary conditions.
It is also important to ensure that any exercise programme is balanced to the needs of the individual; particularly if they already suffer from diabetes. For example, aerobic exercise such as running can lower blood sugar straight away, whilst anaerobic exercise such as weight lifting can take some hours before blood sugar levels are affected.  That important reminder comes from an article which also suggests spreading carbs out over the day to help to manage blood sugar levels. This again highlights the importance of a balanced diet in managing diabetes. The authors of this article also suggest using a SMART (specific, measurable, attainable, relevant, time-bound) programme when setting weight loss or healthy eating goals.
Despite the success of the NHS programme, it has to be acknowledged that simple weight loss programmes may not be enough for some individuals.
One 2015 research paper even commented that “weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors.”
This, the paper says can lead to a need for alternative options, such as pharmacotherapy, to be considered. One complication highlighted by the article is that traditional glucose-lowering medications can even lead to weight gain, not an ideal outcome when weight loss allied to “intensive lifestyle interventions have been shown to reduce the incidence of diabetes by 58%.”
Interestingly a 2022 paper which looked at the effects of weight loss in Chinese and American individuals found that the association between obesity and Type 2 diabetes decreased with ageing.
This suggests that weight loss programmes may not be as effective at managing diabetes for older individuals than for their younger cohorts. Nevertheless, this is not an excuse to drop weight loss programmes. That link between weight and diabetes remains; with obesity also potentially contributing to a range of conditions including heart problems, high blood pressure and loss of sight.
There is no doubt that weight management can play a key role in preventing or reducing the impact of diabetes. But to see it as the only solution would be to ignore the often complex interplay of metabolism and fitness which can impact so many conditions. Taking a more holistic viewpoint enables physicians to provide appropriate interventions, whether they be lifestyle or pharmacological.
As diabetes is on the rise globally, at Occuity we are working on a solution that will offer pain-free, non-invasive blood glucose monitoring and screening. Discover our technology or support our work by joining our diabetes community to help us with future surveys, trials and studies.