Type 2 diabetes operates differently across weight profiles

From healthcare-in-europe.com

Despite opposing biological mechanisms, medical professionals currently treat both groups with the exact same medications

Research published in Diabetologia by Amsterdam University Medical Center (Amsterdam UMC) and the University of Ghana reveals that type 2 diabetes manifests in two fundamentally different ways depending on a patient's body mass index (BMI). While type 2 diabetes in patients with a higher BMI is primarily driven by insulin resistance, the study demonstrates that in individuals within a lower BMI range, the condition is caused by the pancreas failing to produce sufficient insulin. Despite these opposing biological mechanisms, medical professionals currently treat both groups with the exact same medications. 

Type 2 diabetes is generally seen as a disease associated with being overweight. In wealthy countries that picture holds true: nine out of ten people with type 2 diabetes are overweight. In Africa the situation is different. Almost four in ten African adults with type 2 diabetes are lean, with a normal or even low body weight. In some rural areas, such as in Ghana, it is as many as six in ten. First Author Sabrina Esmail: "This means that there are an estimated ten million lean patients on the African continent who do not fit the standard picture. For them, the problem is therefore a shortage of insulin, not a reduced response to insulin." Project leader Charles Agyemang at Amsterdam UMC believes “this study shows that we need to look for better treatments for this large group of lean Africans."  

Yet in Africa both groups are almost always given the same treatment, based on international guidelines: oral tablets such as metformin or sulfonylureas. These medicines, however, are mainly effective against insulin resistance, not against a shortage of insulin. They are therefore probably receiving the wrong treatment, and until now the consequences of this had not been investigated. 

The researchers analysed data from more than 3,300 African adults with type 2 diabetes from Ghana, Nigeria, Kenya and Europe. "From this we concluded that lean patients more often develop eye damage, known as retinopathy, and strokes. People who are overweight, by contrast, more often have high blood pressure and an increased risk of cardiovascular disease. Chronic kidney disease occurred equally often in both groups," says senior author Felix Chilunga. The amount of body fat explained the greater part of these differences, which points to genuinely different disease processes. The risk factors differ as well: whereas being overweight is often linked to an unhealthy lifestyle, lean patients have more often experienced malnutrition or a low birth weight, which can disrupt the development of the pancreas. 

Type 2 diabetes in lean Africans is therefore, biologically and clinically, a different type of disease from the one seen in people who are overweight. But it is still being treated as though it were the same. As a result, millions of people may not be receiving the right care. Chilunga: "We are calling for targeted clinical trials to determine which treatment works best for this large and often overlooked group of patients." 

For Africans in Europe, too, it is very likely that a different treatment is needed. Another study with analysis from data from the UK Biobank showed that people of African descent with a BMI of 26 already have the same diabetes risk as Europeans with a BMI of 30. Studies of migrants in Europe consistently show that Africans are more likely to have type 2 diabetes, develop it around ten years earlier, and have poorer blood sugar control than the native population. Agyemang: "So a considerable proportion of African patients in Europe have a lower BMI but are treated according to guidelines written for the form of the disease found in people who are overweight, and their control is demonstrably worse. There is no reason to assume that the treatment mismatch we describe stops at the border." 

This study was carried out by Amsterdam UMC, University of Ghana, the national Institutes of Health (Center for Research on Genomics and Global Health) via de cohorts AADM and RODAM.  

https://healthcare-in-europe.com/en/news/type-2-diabetes-different-weight.html

5 Myths About Diabetes You Need to Stop Believing, According to Dietitians

From eatingwell.com

Think you know the truth about diabetes? These common myths might be standing in the way between you and better health 

KEY POINTS

• Many diabetes myths still exist and can lead to worse health outcomes.
• Diabetes is a complex chronic disease; it’s not caused by eating too much sugar or carbs.
• Manage diabetes by eating a balanced diet, staying physically active and working with a diabetes specialist.

Even with all we know about diabetes today, myths about the condition continue to spread. Unfortunately, these myths can make the condition harder to manage—fuelling shame, stigma and, ultimately, poorer health outcomes.

So let’s clear things up. With insights from diabetes nutrition experts, we dive into the top five diabetes myths we wish people would finally let go of, and what you should be doing instead.

                                                                                            Credit: Getty Images. EatingWell design

Myth #1: Eating Sugar Causes Diabetes

While sugar may have a bad reputation, it’s not the primary cause of diabetes. In fact, type 1 diabetes and type 2 diabetes have completely different underlying causes. Type 1 diabetes is an autoimmune disease in which the immune system attacks insulin-producing cells in the pancreas, leading to little or no insulin production. Type 2 diabetes, on the other hand, is more complicated. It typically stems from a combination of factors such as genetics, insulin resistance, body composition and lifestyle habits like diet and physical inactivity.

“Type 2 diabetes doesn’t have a single cause, especially not sugar alone. Diets high in ultra-processed foods, which often contain added sugars, fats and refined carbs, have been linked to insulin resistance and glucose dysregulation,” says Ina Flores, M.S., RD, CDCES. Although eating too much added sugar can play a role in the development of type 2 diabetes, it’s not a direct cause. “It’s not about one food or ingredient. It’s about the overall dietary pattern and metabolic health,” Flores says.

Myth #2: People with Diabetes Can’t Eat Carbs

A common misconception is that people with diabetes must avoid carbohydrates altogether. In reality, all carbs can fit in a diabetes-friendly diet—with the right guidance. Fibre-rich carbohydrates like legumes, whole grains, fruit and vegetables are especially good choices. They digest more slowly,  support glycaemic control and provide essential vitamins and minerals that are important for diabetes management.

It’s also important to consider what you’re pairing with your carbs. “Combining carbs with protein, fat or fibre—like pairing fruit with nuts or crackers with cheese—can help slow digestion and keep blood sugar steadier,” says Tamar Samuels, M.S., RD, CDN.

Of course, some individuals may need to monitor their carbohydrate intake and avoid consuming too much in one sitting. Working closely with a registered dietitian or diabetes specialist can help you better understand how your blood sugar responds to different types and amounts of carbs.

Myth #3: Being on Insulin Means You Failed

Although some people can manage type 2 diabetes with lifestyle changes alone, this isn’t possible for everyone. Diabetes is a chronic, progressive disease, which means your management plan can change over time. Insulin is the hormone that allows blood sugar to enter your cells, and in type 2 diabetes, the body’s ability to produce it can decline—even with healthy habits. When there isn’t enough insulin, blood sugar builds up and can cause damage throughout the body. Taking insulin can be a life-saving tool to keep your blood sugar levels balanced—and isn’t a sign of failure. For people with type 1 diabetes, insulin is essential for survival, as their pancreas no longer produces it, regardless of lifestyle habits. 

“Starting an insulin regimen isn’t about giving up or failing, it’s about giving your body what it needs,” says Flores. “It’s a powerful, life-saving therapy.” 

Myth #4: If You Have a Normal BMI, Diabetes Won’t Affect You

It’s a common misconception that body mass index (BMI) is a reliable measure of overall health. In reality, BMI doesn’t distinguish between muscle and fat or account for other contributing factors like genetics, ethnicity, environment, age and stress. For example, a person classified as “obese” based on BMI may have a healthy body composition with higher muscle mass and lower fat mass, while someone with a “normal” BMI may carry excess fat and have low muscle mass—putting them at greater risk for health issues.

In fact, research suggests that central adiposity—fat stored around the abdomen—is a stronger predictor of diabetes risk than BMI. Still, even individuals with a lower or “normal” BMI can develop type 2 diabetes. “It would be wrong to assume those in the normal range BMI category are protected from developing type 2 diabetes. We need to acknowledge other risk factors of blood sugar dysregulation and insulin resistance to avoid missed diagnoses,” says Meredith Rofheart, M.S., RD, CDN.

Myth #5: Diabetes Is Reversible

While there isn’t currently a cure for diabetes—though hopefully there will be one day—it is possible to reach remission, meaning you can manage your blood sugar levels without medication. “Remission is possible for some people with type 2 diabetes, especially after significant weight loss and early intervention, but it’s not a cure,” says Flores. “Maintaining remission requires ongoing lifestyle changes, regular medical follow-up and support. Weight regain or declining beta cell function can lead to relapse, so long-term support is essential.”

Although promising advancements are underway in the treatment of type 1 diabetes, it remains a non-reversible condition that requires ongoing medical management.

Believe These Instead

Despite the myths out there, there are many lifestyle habits that can help you effectively manage your diabetes.

• Balance Your Plate. Combine protein, healthy fats and fibre-rich carbs to stabilize blood sugar.
  
• Move More. Staying physically active can help better manage blood sugar levels. This includes activities like strength training, cardio, playing sports and going for walks. It’s also important to reduce long sitting and sedentary time throughout the day.
  
• Monitor Your Portions. Being mindful of portion sizes can help you manage your carbohydrate and calorie intake. A helpful guideline is to fill half of your plate with non-starchy vegetables, one quarter with complex carbohydrates, and the remaining quarter with lean protein.
  
• Get Screened Early. If you have a family history of diabetes or other risk factors, it’s important to speak with your health care provider. Early detection can help you take steps to prevent or delay complications.
  
• Work with a Professional. A registered dietitian or certified diabetes care and education specialist (CDCES) can help personalize your plan that fits with your lifestyle and individual needs.
  
  

Our Expert Take

The myths around diabetes aren’t just wrong—they’re harmful. They can trap people in fear, shame and confusion—often delaying effective care. But here’s the truth: diabetes management isn’t about perfection or punishment. It’s about meeting people where they are—understanding their barriers, helping them navigate the emotional challenges of the condition and equipping them with the knowledge and skills necessary for self-care. Whether you’re trying to prevent, manage or simply understand diabetes better, replacing myths with facts can make all the difference.

https://www.eatingwell.com/diabetes-myths-to-stop-believing-11781817

Managing body weight is key driver out of all lifestyle factors in reducing type 2 diabetes risk

From diabetes.co.uk/news

New research has demonstrated that while a number of healthy lifestyle behaviours can cut the risk of type 2 diabetes, managing body weight remains a key driver, particularly when it comes to different ethnic groups.

The risk of developing type 2 diabetes can be influenced by both a person’s genetics and their lifestyle, which includes diet, alcohol intake, smoking and physical activity.

These behaviours can be combined into a lifestyle index to better predict diabetes risk.

However, previous studies only covered short follow-up periods so in this latest research, the team examined how combined lifestyle behaviours influence type 2 diabetes risk across different population groups over time, using a composite Lifestyle Risk Factor Index (LSRI).

A key finding was that participants in the study classed as obese – with a body mass index over 30 – were more than three times more likely to develop type 2 diabetes compared to those with a normal weight.

The international team of authors concluded that body mass index (BMI) had a stronger link with type 2 diabetes risk than LSRI, saying: “The LSRI’s significant association with type 2 diabetes risk persisted even after adjusting for BMI, indicating its independent significance.

“However, the influence of overweight and obesity on type 2 diabetes, when adjusted for LSRI, was notably stronger. This underscores that while LSRI captures key lifestyle factors affecting type 2 diabetes risk, BMI remains the strongest predictor.

“In summary, our study demonstrates significant ethnic differences in how lifestyle factors and BMI affect type 2 diabetes incidence.”

The research highlights how important it is to combine lifestyle habits through an index to assess diabetes risk.

The study group, which was made up of 165,383 participants, included European American, African American, Native Hawaiian, Japanese American, and Latino volunteers.

The research revealed that a higher LSRI score was associated with much lower type 2 diabetes incidence, particularly among the African American, Latino, and European American groups.

This suggests the need for public health programmes that are tailored to different ethnic groups.

https://www.diabetes.co.uk/news/2025/jun/managing-body-weight-is-key-driver-out-of-all-lifestyle-factors-in-reducing-type-2-diabetes-risk.html

These 4 factors can predict if you’ll get diabetes within 10 years — most have nothing to do with weight

From nypost.com

Turns out, you can’t outrun diabetes with a low BMI. 

In a sweeping study of nearly 45,000 participants, researchers set out to determine what drives the progression from prediabetes to diabetes — and weight is only one facet.

They found that factors like age, sex and fasting plasma glucose levels, or the amount of sugar in your blood, all play a significant role as well.

4

More than 38 million Americans have been diagnosed with Type 2 diabetes.        habrovich – stock.adobe.com

“The study highlights that the prevalence of diabetes is increasing in the world and that we need to highlight the importance of prevention, regardless of medical history, because we see that the risk is increased across all types of patients, including lower BMI patients,” Dr. Danielle Brooks, an endocrinologist at North Shore University Hospital who was not involved with the study, told The Post.

In the study, published Thursday in the journal JAMA Network Open, the average age of participants was 43.7 years, with an average BMI of 28.9, which is considered overweight. 

Their fasting plasma glucose levels ranged from normal (70-100 mg/dL) to impaired (100-125 mg/dL), placing the latter group in the prediabetes zone, where blood sugar is elevated but not yet in the diabetic range.

Over a median follow-up of 6.8 years, 8.6% of participants developed diabetes — and the researchers estimated that number would be 12.8% chance within 10 years.

A particularly eye-popping finding was that any FPG level outside of the narrow range of 80 to 94 mg/dL — even if still considered normal — was linked to a heightened risk of developing diabetes. 

Abnormal BMI categories, including those considered underweight, were also associated with increased risk.

“The authors postulate that there was an increased risk for this section of individuals based on potentially having a malnourished state as an individual increased risk factor for insulin resistance and development of diabetes, which is not something that we typically think about,” Brooks added. 

Researchers also found that men were more likely to develop diabetes than women, while older age was similarly linked to a higher risk.

Notably, the study revealed a significant additive relationship between key variables, especially between FPG levels and BMI.

For example, a woman aged 55 to 59 years with a BMI of 18.5 to 24.9 and an FPG level of 95 to 99 mg/dL had a 7% chance of developing diabetes within 10 years. 

But if her BMI increased to 30 to 34.9, her risk almost doubled to 13%. If her FPG level also rose to 205 to 209 mg/dL, her risk shot up to 28%.

One limitation of the study was that more than 87% of participants were Caucasian, leaving questions about how race and ethnicity might interact with other factors to either increase or decrease the risk of developing diabetes.

“We do know that there are increased risks of diabetes development in patients with particular ethnicities,” said Brooks. “I think further research is definitely needed in that area to further individualize patient care and patient prevention for diabetes development.

What you can do now

As the US grapples with an obesity epidemic, the number of people with diabetes continues to rise. According to the CDC, nearly 98 million Americans have prediabetes, and over 38 million have Type 2 diabetes.

Brooks says the study underscores the need for doctors to be hyperaware of increased diabetes risk in every patient — not just those who are overweight or have a history of the disease. 

“We need to be hyper aware of this trend in our health,” she said. 

Researchers believe the findings could help guide both doctors and patients in implementing lifestyle and pharmacologic interventions for those at the highest risk, ultimately aiming to reduce future morbidity and mortality from the disease. 

In 2022, 101,209 Americans died from diabetes, which was the eighth leading cause of death.

Currently, metformin is the primary option for delaying or preventing Type 2 diabetes with medication. But new research shows that next-generation weight-loss drugs, like tirzepatide, could also reduce the risk of developing the disease in overweight or obese individuals.

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Lifestyle factors like diet and exercise can lower your risk of developing diabetes.                                                  peopleimages.com – stock.adobe.com

If you’re not ready to reach for the medicine cabinet just yet, there are still plenty of everyday steps you can take to lower your diabetes risk.

“Leading a healthy lifestyle in terms of achieving the general recommended amount of exercise per week is one of the foundations of diabetes prevention,” said Brooks, who recommended aiming for 150 minutes of exercise per week.

Managing your food choices is just as crucial, especially at a time when 60% of the average U.S. diet consists of ultra-processed foods, like sugary cereals, frozen pizzas and potato chips.

Brooks advises focusing on a low-carb, high-protein diet to maintain a healthy weight over time and help prevent diabetes.

https://nypost.com/2025/01/23/health/weight-isnt-the-only-factor-driving-diabetes-risk-3-other-drivers/

Type 2 diabetes remission likely for adults with ‘healthy’ BMI and 10% weight loss

From healio.com

Adults with type 2 diabetes and a BMI of 21 kg/m² to 27 kg/m² have high likelihood of diabetes remission if they lose 10% of their starting weight, researchers reported.

“Type 2 diabetes is often considered to be ‘caused’ by a higher body mass index, and certainly there is a strong link between increasing weight, increasing BMI and the incidence of type 2 diabetes,” Alison C. Barnes, RD, lead research associate and dietitian at the Human Nutrition Research Centre at Newcastle University, Newcastle upon Tyne, U.K., said during a presentation at the European Association for the Study of Diabetes annual meeting. “However, if we look at the numbers, 15% of new diagnoses of type 2 diabetes are actually in people who have a BMI within that healthy range.”

Most adults with type 2 diabetes and a BMI of 21 kg/m² to 27 kg/m² achieve diabetes remission with 10% or more weight loss. Data were derived from Taylor R, et al. Abstract #255. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 19-23, 2022; Stockholm (hybrid meeting).

Researchers enrolled 20 adults with type 2 diabetes (mean age, 59 years; 65% women) who were at or within the healthy BMI range who underwent up to three cycles of 5% weight loss using a low-calorie diet of 800 calories daily of formula meal replacements and low starch vegetables. Researchers compared weight loss results with those for 20 adults without type 2 diabetes who were matched by age, sex and BMI. Participants maintained their weight loss for 46 weeks.

Overall, participants with type 2 diabetes experienced an average weight loss of 7.7 kg, or 10.7%, of initial body weight. Participants reported feeling “better and satisfied” with their weight at the conclusion of the study, Barnes said. Researchers also noted that participants were able to maintain their weight loss between 6 and 12 months (24.8 vs. 22.4 kg/m²). Waist measurement and body fat were reduced to normal levels in men with type 2 diabetes but remained higher among women with type 2 diabetes compared with matched participants.

Seventy percent of participants achieved diabetes remission, which was similar to that observed in previous studies of adults with higher BMI, according to Barnes.

In addition, researchers observed a mechanism underlying diabetes remission involving reducing fat in the liver and pancreas. Baseline liver fat levels were 2.5 times higher among participants with type 2 diabetes than in the matched control group but reduced to less than 2% by 24 weeks. This was also observed in previous studies, Barnes said.

As fat volume in the liver and pancreas decreased, blood glucose levels decreased and insulin levels increased, according to Barnes. Fasting plasma glucose responded quickly with HbA1c improving from 54 mmol/mol to 46 mmol/mol at 12 months. Insulin secretion also improved but remained below that of the matched control group.

“Regardless of BMI, people who are diagnosed with type 2 diabetes simply have more fat inside their body than they can cope with. The positive message is that there is a good chance of remission for people with a BMI of below 27 [kg/m²] if they’re able to lose around 10% of their starting weight,” Barnes said. “This data can offer a frameshift in our thinking; to see weight loss as a valuable therapeutic option for people who are diagnosed with type 2 diabetes at lower BMI.” 

https://www.healio.com/news/endocrinology/20220930/type-2-diabetes-remission-likely-for-adults-with-healthy-bmi-and-10-weight-loss

Reversing type 2 diabetes: Visceral fat more important than overall weight

From medicalnewstoday.com

• Researchers have shown that for people with overweight or obesity, losing weight can reverse type 2 diabetes.
• In a small study, the team found that weight loss reversed type 2 diabetes in participants, even though their body mass index (BMI) was in a moderate range.
• The study authors believe that lowering levels of fat around the organs may be more important than lowering BMI.

In a small, preliminary study, researchers have found that people with type 2 diabetes who also have a BMI that falls within a moderate range can reverse their diabetes by losing weight.

The researchers reported their findings at the Annual Meeting of the European Association for the Study of Diabetes. 

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes, accounting for around 91.2%Trusted Source of diabetes cases in the United States.

The condition occurs when a person’s body does not produce enough insulin or if the insulin no longer works effectively. Insulin normally helps glucose enter the cells of the body. In the absence of insulin, glucose stays in the blood, where it can damage organs and tissues.

This means that a person with type 2 diabetes has an increased risk of several health issues, including stroke, heart disease, issues with their feet, kidney disease, dental issues, and bladder problems.

According to researchers writing in the journal Nutrients, scientists for a long time believed that type 2 diabetes was incurable, so they primarily focused on how people should manage symptoms of the condition.

However, evidence now suggests that if individuals who are overweight or have obesity achieve and maintain weight loss, they can reverse type 2 diabetes.

Weight loss without overweight?

In the present small, preliminary study, researchers have gone one step further and examined whether weight loss might reverse type 2 diabetes even in those whose weight falls within the moderate BMI range.

Medical News Today spoke with the study’s first author, Dr. Ahmad Al-Mrabeh, a Transitional Research Fellow at the Centre for Cardiovascular Science at Queen’s Medical Research Institute at the University of Edinburgh in the United Kingdom.

He explained that they decided to explore whether weight loss could be effective at reversing type 2 diabetes for people with moderate BMI after looking at the results of their previous research.

“We observed that the metabolic profile changed markedly after following a low calorie diet even when the change in body weight was […] minor. We, therefore, wanted to test whether inducing modest weight loss could achieve remission in those who are non-obese,” said Dr. Al-Mrabeh.

According to the principal investigator of the study, Prof. Roy Taylor, Director of the Newcastle Magnetic Resonance Centre at Newcastle University, U.K., “[o]ur previous research has shown that weight loss of 10–15% can achieve remission in people with type 2 diabetes who are overweight or obese.”

“Doctors tend to assume, however, that type 2 diabetes has a different cause in those who aren’t overweight. This means that, unlike those who are overweight, those who are of [moderate] weight aren’t usually advised to lose weight before being given diabetes drugs and insulin.”

“Instead, there’s a tendency to start them on insulin and other medication at a much earlier stage.”

“What we’ve shown is that if those of [moderate] weight lose 10-15% of their weight, they have a very good chance of getting rid of their diabetes.”

Preliminary study

The study involved just 23 people. Of these, 12 individuals had a type 2 diabetes diagnosis with an average age of 58.3 years and an average BMI of 24.5. The remaining 11 did not have diabetes and were of similar age and BMI. This group acted as the control.

The Centres for Disease Control and Prevention (CDC) classify BMI scores of 18.5-24.9Trusted Source as “healthy.”

All participants followed a low calorie diet for 2 weeks, consuming no more than 800 calories each day. The researchers then supported them to maintain their new weight for 4–6 weeks.

They completed this cycle two or three times until all participants had reduced their body weight by 10–15%.

The researchers measured each participants’ visceral fat and insulin sensitivity before, during, and after the study.

Remission in two-thirds

At the end of the study, the researchers matched the people with diabetes with control participants of the same age, sex, and BMI. The scientists found that the individuals with diabetes lost more than twice as much fat in their liver compared with the controls.

In the diabetes group, fat in the pancreas reduced from 5.1% to 4.5%. Also, their average triglyceride levels fell from 1.6 millimoles per litre to 1.0 millimoles per litre — a significant reduction similar to the control group.

Most significantly, two-thirds of the participants found that their type 2 diabetes went into remission and could stop taking their medication.

Prof. Taylor says that “[t]hese results, while preliminary, demonstrate very clearly that diabetes is not caused by obesity but by [carrying too much weight] for your own body. It’s due to having too much fat in your liver and pancreas, whatever your BMI.”

“In the liver, this excess fat prevents insulin from working normally. In the pancreas, it causes the beta cells to stop producing insulin.”

Dr. Al-Mrabeh said to MNT that the results may be reproducible in larger studies, “however, it is important to understand the mechanisms of excess fat build-up within these vital metabolic organs (liver and pancreas) in non-obese people.”

Speaking with MNT, Prof. Pål R. Njølstad, Leader of the Centre for Diabetes Research at the University of Bergen, Norway, said that “[t]he findings are interesting and indicate that weight loss is also important in non-obese individuals with type 2 diabetes.”

Prof. Njølstad added that “[m]ore studies are needed with an increased number of study participants and increased time of follow up, in addition to investigating the effect of other factors, such as age, sex, and ethnicity.”

Dr. Al-Mrabeh said to MNT that he will continue developing the initial findings.

“I have recently moved to the University of Edinburgh to establish an independent research program looking into the mechanisms of how excess fat causes damage to the pancreas in type 2 diabetes. My aim is to dissect these mechanisms using both human and animal studies.”

https://www.medicalnewstoday.com/articles/reversing-diabetes-visceral-fat-more-important-than-overall-weight#Remission-in-two-thirds