This post is written by Osama Hamdy, M.D., Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management at Joslin Diabetes Center, Assistant Professor of Medicine at Harvard Medical School.
In my research and clinical work in the Joslin Clinic, I have long maintained that we need to rethink the treatment of patients with type 2 diabetes.
I believe that targeting weight loss and not just diabetes control will likely prove to be more effective than focusing on blood glucose levels alone, and will help lower the cost of managing diabetes.
We know that weight loss helps tremendously with the management of type 2 diabetes. In our research, when obese adults with diabetes lost seven percent of their body weight (only 14 pounds if you weigh 200 pounds), insulin action improved by around 57 percent—more than you can get with most diabetes pills. In addition, weight loss helps lower blood pressure, cholesterol levels, blood fats, and heart disease risk.
We’ve already proven that this approach works, here at Joslin, in our Why WAIT™ program. Why WAIT is a 12-week outpatient program for weight loss and intensive blood glucose control that focuses on using weight-friendly diabetes medications and reducing or eliminating ones that promote weight gain (more on that in my next article, to be posted soon).
We’ve combined this with physical activities (like resistance training), balanced eating, stress management, and lasting behavior change. Our participants have lost an average of 23.8 pounds (almost 10 percent of their body weight) after only 12 weeks. What’s more, they’ve been able to keep off most of it (an average of 16.2 lbs) five years later, while most people on other diets gain their weight back.
Our participants have also been able to reduce their diabetes medications. Many types of insulin can cause you to gain weight, but 21 percent of our participants with type 2 diabetes who were treated with insulin at the beginning of the program stopped taking insulin by the end of the program. Those who still needed insulin decreased their doses by over 50 percent, which made it easier for them to avoid both weight regain and low blood glucose levels.
Participants in the Why WAIT™ Program were also able to cut the number of diabetes pills by 50 to 60 percent and many of them stopped taking diabetes medications altogether.
And as far as costs are concerned, the average Why WAIT participant saved $140 on diabetes medications during the 12-week program, which equates to saving $561 a year.
In my next article, I’ll go over the difference between diabetes medications that are weight friendly and those that cause weight gain.