Liver fat at the heart of type 2 diabetes

There has been a great deal of interest in the work the NHS has done with its Diabetes Direct service in helping people put their diabetes into remission by losing weight. Type 2 diabetes always improves after weight loss, which is very well established. Every single consultation on type 2 diabetes should concentrate on lifestyle changes that will help people live with the disease more successfully and the most important of these are to get more regular daily exercise and to lose weight.

Weight loss helps diabetes because there is also weight lost from the liver, pancreas and internal visceral fat and it is the fat in these key places of the body which determine insulin resistance. Weight loss from these areas makes your body more sensitive to your own insulin and so your glucose readings improve, and you can need less medication.

Interesting new research has highlighted the importance of reducing liver fat in improving glucose levels. So instead of treating the glucose alone with medications that target other organs, we should also target liver fat; implicit in this is weight loss.

For the last 14 years we have had wonderful drugs used in diabetes called GLP1 agonists which have shown that they are able not only to reduce liver fat but to reduce appetite and help people lose weight and they are amongst the strongest drugs we have for diabetes. We started with liraglutide (Victoza) nearly 14 years ago, which was a daily injection, but now we have progressed to strong drugs that are used weekly by injection – Trulicity or Ozempic or even by daily tablet – Rybelsus.

I have personally used these drugs in my diabetes practice and can vouch for their efficacy and popularity. I think the GLP1 agonists are the best thing that have ever been introduced for diabetes and I believe that most diabetes patients who are even mildly overweight would benefit from the use of these drugs.  The only people who should not be prescribed these drugs are those people who are thin and those who are unable to overcome the initial side effects which can be severe in occasional patients. The big additional advantage these drugs is not simply that they are the most powerful diabetes medications around and they lead to substantial weight loss effortlessly in a great many patients, but they are also good for the kidneys and the heart.

The majority of patients with established diabetes would benefit from these additional advantages. If you are overweight and you have type 2 diabetes, you should be asking whether one of the GLP1 agonists should be included in your medication list not simply for your glucose levels but for your heart or for your weight or for your fatty liver or for your sleep apnoea or for your knee and hip and back pain – all of which may improve with the resulting weight loss.