Extinguishing the Fire: Treating Pediatric Type 2 Diabetes by Targeting Obesity Treatment

Childhood obesity affects nearly one in five children in the U.S. and is a key driver in youth-onset type 2 diabetes (T2D) development and progression. Effective obesity treatment may lead to T2D remission and can greatly improve dysglycemia and insulin sensitivity. The main objective of this article is to describe the growing evidence in support of targeting obesity to treat T2D in youth. There is growing evidence and guidance that for adults with T2D medical and surgical treatments for obesity should be prioritized. Yet, for youth with T2D, there has been limited movement to prioritize treating obesity, despite its role in diabetes pathophysiology. In adults, addition of obesity medications and bariatric surgery to the diabetes treatment regimen results in substantial weight reduction, improvement in dysglycemia, and decreased use of diabetes agents. In youth, there is limited, yet mounting evidence of these same benefits. U.S. Food and Drug Administration-approved obesity medications are effective and well tolerated in youth with obesity and an important therapeutic tool for youth with T2D and obesity. For several medications clinically significant weight reduction has been demonstrated, with improvement in insulin resistance and dysglycemia. In youth with T2D significant weight reduction has been demonstrated with bariatric surgery, with significant 3- and 10-year diabetes remission rates. Further studies in pediatric patients with T2D and obesity are needed to determine the long-term impacts of obesity therapies and bariatric surgery on progression and outcomes of youth-onset T2D.