COMPREHENSIVE TREATMENT OF TYPE 2 DIABETES IN PATIENTS WITH OBESITY: THE ROLE OF PATIENT EDUCATION, WEIGHT REDUCTION, PHARMACOTHERAPY AND LIFESTYLE MODIFICATION - A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5796Keywords:
Type 2 Diabetes, Obesity, Patient Education, Weight Reduction, Pharmacotherapy, Lifestyle ModificationAbstract
Type 2 diabetes and obesity are closely connected chronic conditions that require a comprehensive, patient-centred approach. Traditional management focused primarily on glycaemic control, whereas contemporary care increasingly recognizes weight reduction, cardiovascular-kidney-metabolic risk reduction and digital health tools as integral components of treatment. This narrative review synthesizes current evidence on the complex management of type 2 diabetes in adults with obesity, with emphasis on diabetes self-management education and support, intentional weight loss, lifestyle modification, pharmacotherapy and technology-enabled care. Publications were selected from PubMed-indexed literature, clinical guidelines, systematic reviews, meta-analyses and randomized controlled trials relevant to the intersection of diabetes, obesity, education, lifestyle and innovative health technologies. Education can improve glycaemic control and adherence. Structured weight-management interventions can support clinically meaningful weight loss and, in selected patients, remission of type 2 diabetes. Nutrition therapy and physical activity remain foundational, but their implementation requires individualized counselling, behavioural strategies and attention to social determinants of health. Pharmacotherapies such as metformin, sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors), glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (dual GIP/GLP-1 receptor agonists) have shifted treatment from a purely glucose-centred model toward weight-centred. Digital health applications, wearable devices and continuous glucose monitoring may strengthen education and self-management, although equity and long-term engagement remain. Integrated care models combining education, weight management, pharmacotherapy and digital follow-up are likely to produce the greatest clinical and public health benefit.
References
American Diabetes Association Professional Practice Committee for Diabetes. (2026a). Obesity and weight management for the prevention and treatment of diabetes: Standards of Care in Diabetes—2026. Diabetes Care, 49(Suppl. 1). https://doi.org/10.2337/dc26-S008
American Diabetes Association Professional Practice Committee for Diabetes. (2026b). Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2026. Diabetes Care, 49(Suppl. 1). https://doi.org/10.2337/dc26-S009
Anyiam, O., Ardavani, A., Abdul Rashid, R. S., Panesar, A., & Idris, I. (2025). How do glucagon-like peptide-1 receptor agonists affect measures of muscle mass in individuals with, and without, type 2 diabetes: A systematic review and meta-analysis. Obesity Reviews, 26, e13916. https://doi.org/10.1111/obr.13916
Aroda, V. R., Jørgensen, N. B., Kumar, B., Lingvay, I., Laulund, A. S., & Buse, J. B. (2025). High-dose semaglutide (up to 16 mg) in people with type 2 diabetes and overweight or obesity: A randomized, placebo-controlled, phase 2 trial. Diabetes Care, 48(6), 905–913. https://doi.org/10.2337/dc24-2425
Barrios Quinta, C. J., et al. (2022). Reducing health inequalities among most disadvantaged type 2 diabetes patients: A cross-sectional exploratory pilot study. Journal of Nursing Scholarship. https://doi.org/10.1111/jnu.12781
Bentley, C. L., Otesile, O., Bacigalupo, R., Elliott, J., Noble, H., Hawley, M. S., Williams, E. A., & Cudd, P. (2016). Feasibility study of portable technology for weight loss and HbA1c control in type 2 diabetes. BMC Medical Informatics and Decision Making, 16, 92. https://doi.org/10.1186/s12911-016-0331-2
Bergmann, N. C., Davies, M. J., Lingvay, I., & Knop, F. K. (2023). Semaglutide for the treatment of overweight and obesity: A review. Diabetes, Obesity and Metabolism, 25(1), 18–35. https://doi.org/10.1111/dom.14863
Bretschneider, M. P., Kolasińska, A. B., Šomvárska, L., Klásek, J., Mareš, J., & Schwarz, P. E. H. (2025). Evaluation of the impact of mobile health app Vitadio in patients with type 2 diabetes: Randomized controlled trial. Journal of Medical Internet Research, 27, e68648. https://doi.org/10.2196/68648
Chobot, A., Górowska-Kowolik, K., Sokołowska, M., & Jarosz-Chobot, P. (2018). Obesity and diabetes: Not only a simple link between two epidemics. Diabetes/Metabolism Research and Reviews, 34, e3042. https://doi.org/10.1002/dmrr.3042
Chowdhury, H. A., Harrison, C. L., Siddiquea, B. N., et al. (2024). The effectiveness of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis. PLOS ONE, 19, e0297328. https://doi.org/10.1371/journal.pone.0297328
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926–943. https://doi.org/10.1016/j.pec.2015.11.003
Davies, M. J., Aroda, V. R., Collins, B. S., Gabbay, R. A., Green, J., Maruthur, N. M., Rosas, S. E., Del Prato, S., Mathieu, C., Mingrone, G., Rossing, P., Tankova, T., Tsapas, A., & Buse, J. B. (2022). Management of hyperglycemia in type 2 diabetes, 2022: A consensus report by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 45(11), 2753–2786. https://doi.org/10.2337/dci22-0034
Dickinson, W. P., Dickinson, L. M., Jortberg, B. T., Hessler, D. M., Fernald, D. H., Cuffney, M., & Fisher, L. (2019). A cluster randomized trial comparing strategies for translating self-management support into primary care practices. Journal of the American Board of Family Medicine, 32(3), 341–352. https://doi.org/10.3122/jabfm.2019.03.180254
Enricho Nkhoma, D., Jenya Soko, C., Joseph Banda, K., Greenfield, D., Li, Y. C., & Iqbal, U. (2021). Impact of DSMES app interventions on medication adherence in type 2 diabetes mellitus: Systematic review and meta-analysis. BMJ Health & Care Informatics, 28, e100291. https://doi.org/10.1136/bmjhci-2020-100291
Esteves-Stanford, A., & Stanford, K. I. (2024). Exercise as a tool to mitigate metabolic disease. American Journal of Physiology-Cell Physiology. https://doi.org/10.1152/ajpcell.00144.2024
Forouhi, N. G. (2023). Embracing complexity: Making sense of diet, nutrition, obesity and type 2 diabetes. Diabetologia. https://doi.org/10.1007/s00125-023-05873-z
Gadde, K. M., Martin, C. K., Berthoud, H. R., & Heymsfield, S. B. (2018). Obesity: Pathophysiology and management. Journal of the American College of Cardiology, 71(1), 69–84. https://doi.org/10.1016/j.jacc.2017.11.011
Garvey, W. T., Batterham, R. L., Bhatta, M., Buscemi, S., Christensen, L. N., Frias, J. P., Jódar, E., Kandler, K., Rigas, G., Wadden, T. A., Wharton, S., & the STEP 5 Study Group. (2022). Two-year effects of semaglutide in adults with overweight or obesity: The STEP 5 trial. Nature Medicine, 28, 2083–2091. https://doi.org/10.1038/s41591-022-02026-4
Garvey, W. T., Birkenfeld, A. L., Dicker, D., Mingrone, G., Pedersen, S. D., Satylganova, A., Skovgaard, D., Sugimoto, D., Jensen, C., & Mosenzon, O. (2020). Efficacy and safety of liraglutide 3.0 mg in individuals with overweight or obesity and type 2 diabetes treated with basal insulin: The SCALE Insulin randomized controlled trial. Diabetes Care, 43(5), 1085–1093. https://doi.org/10.2337/dc19-1745
Glavas, C., Scott, D., Sood, S., George, E. S., Daly, R. M., Gvozdenko, E., de Courten, B., & Jansons, P. (2024). Exploring the feasibility of digital voice assistants for delivery of a home-based exercise intervention in older adults with obesity and type 2 diabetes mellitus: Randomized controlled trial. JMIR Aging, 7, e53064. https://doi.org/10.2196/53064
Gonzalez-Zacarias, A. A., Mavarez-Martinez, A., Arias-Morales, C. E., Stoicea, N., & Rogers, B. (2016). Impact of demographic, socioeconomic, and psychological factors on glycemic self-management in adults with type 2 diabetes mellitus. Frontiers in Public Health, 4, 195. https://doi.org/10.3389/fpubh.2016.00195
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P. L., & Haire-Joshu, D. (2021). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258–279. https://doi.org/10.2337/dci20-0053
Hu, E. H., Tsai, M. L., Lin, Y., Chou, T. S., & Chen, T. H. (2024). A review and meta-analysis of the safety and efficacy of using glucagon-like peptide-1 receptor agonists. Medicina, 60, 357. https://doi.org/10.3390/medicina60030357
Islam, M. M., Poly, T. N., Walther, B. A., & Li, Y. C. (2020). Use of mobile phone app interventions to promote weight loss: Meta-analysis. JMIR mHealth and uHealth, 8, e17039. https://doi.org/10.2196/17039
Karagiannis, T., Avgerinos, I., Liakos, A., Del Prato, S., Matthews, D. R., & Tsapas, A. (2022). Management of type 2 diabetes with the dual GIP/GLP-1 receptor agonist tirzepatide: A systematic review and meta-analysis. Diabetologia, 65, 1251–1261. https://doi.org/10.1007/s00125-022-05715-4
Kalyani, R. R., Neumiller, J. J., Maruthur, N. M., et al. (2025). Diagnosis and treatment of type 2 diabetes in adults. JAMA. https://doi.org/10.1001/jama.2025.5956
Kheniser, K., Saxon, D. R., & Kashyap, S. R. (2021). Long-term weight loss strategies for obesity. The Journal of Clinical Endocrinology & Metabolism, 106(7), 1854–1866. https://doi.org/10.1210/clinem/dgab091
Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic Journal of Medicine, 84(7 Suppl. 1), S15–S21. https://doi.org/10.3949/ccjm.84.s1.03
Kong, S., et al. (2025). Obesity: Pathophysiology and therapeutic interventions. Molecular Biomedicine, 6, 25. https://doi.org/10.1186/s43556-025-00264-9
Konnyu, K. J., Yogasingam, S., Lépine, J., Sullivan, K., Alabousi, M., Edwards, A., et al. (2023). Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database of Systematic Reviews, 5, CD014513. https://doi.org/10.1002/14651858.CD014513.pub2
Li, M., Li, J., Xu, Y., Gao, J., Cao, Q., Ding, Y., et al. (2024). Effect of 5:2 regimens: Energy-restricted diet or low-volume high-intensity interval training combined with resistance exercise on glycemic control and cardiometabolic health in adults with overweight/obesity and type 2 diabetes: A three-arm randomized controlled trial. Diabetes Care, 47(6), 1074–1083. https://doi.org/10.2337/dc24-0241
Liu, Q. K. (2024). Mechanisms of action and therapeutic applications of GLP-1 and dual GIP/GLP-1 receptor agonists. Frontiers in Endocrinology, 15, 1431292. https://doi.org/10.3389/fendo.2024.1431292
Liu, Y., Chen, Y., Ma, J., Lin, J., Liu, C., Li, X., et al. (2025). Dapagliflozin plus calorie restriction for remission of type 2 diabetes: Multicentre, double blind, randomised, placebo controlled trial. BMJ, 388, e081820. https://doi.org/10.1136/bmj-2024-081820
Lu, X., Xie, Q., Pan, X., Zhang, R., Zhang, X., Peng, G., et al. (2024). Type 2 diabetes mellitus in adults: Pathogenesis, prevention and therapy. Signal Transduction and Targeted Therapy, 9. https://doi.org/10.1038/s41392-024-01951-9
Maula, A., Kai, J., Woolley, A. K., Weng, S., Dhalwani, N., Griffiths, F. E., Khunti, K., & Kendrick, D. (2020). Educational weight loss interventions in obese and overweight adults with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetic Medicine, 37(4), 623–635. https://doi.org/10.1111/dme.14193
Mueller, J., Breeze, P., Fusco, F., Sharp, S. J., Pidd, K., Brennan, A., et al. (2025). Glucose Lowering through Weight management (GLoW): A randomised controlled trial of the clinical and cost effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes. Diabetologia, 68, 969–980. https://doi.org/10.1007/s00125-024-06355-6
Müller, T. D., Finan, B., Bloom, S. R., D’Alessio, D., Drucker, D. J., Flatt, P. R., et al. (2019). Glucagon-like peptide 1 (GLP-1). Molecular Metabolism, 30, 72–130. https://doi.org/10.1016/j.molmet.2019.09.010
Nauck, M. A., & D’Alessio, D. A. (2022). Tirzepatide, a dual GIP/GLP-1 receptor co-agonist for the treatment of type 2 diabetes with unmatched effectiveness regarding glycaemic control and body weight reduction. Cardiovascular Diabetology, 21, 169. https://doi.org/10.1186/s12933-022-01604-7
Nishikage, S., Nakagawa, Y., Hirota, Y., Yoshimura, K., Ueda, M., Yamamoto, A., et al. (2025). Effects of intermittently scanned continuous glucose monitoring on body weight and glycemic variability in individuals with overweight and impaired glucose tolerance or mild diabetes: A pilot randomized controlled trial. Obesity Research & Clinical Practice. https://doi.org/10.1016/j.orcp.2025.01.008
O’Neil, P. M., Miller-Kovach, K., Tuerk, P. W., Becker, L. E., Wadden, T. A., Fujioka, K., et al. (2016). Randomized controlled trial of a nationally available weight control program tailored for adults with type 2 diabetes. Obesity, 24, 2269–2277. https://doi.org/10.1002/oby.21616
Pereira, M. J., & Eriksson, J. W. (2019). Emerging role of SGLT-2 inhibitors for the treatment of obesity. Drugs, 79, 219–230. https://doi.org/10.1007/s40265-019-1057-0
Petroni, M. L., Brodosi, L., Marchignoli, F., Sasdelli, A. S., Caraceni, P., Marchesini, G., & Ravaioli, F. (2021). Nutrition in patients with type 2 diabetes: Present knowledge and remaining challenges. Nutrients, 13, 2748. https://doi.org/10.3390/nu13082748
Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of metformin. Diabetologia, 60, 1577–1585. https://doi.org/10.1007/s00125-017-4342-z
Roshan-Nejad, M., Hosseini, M., Vasli, P., Nasiri, M., & Hejazi, S. (2024). Effect of health literacy-based teach-back training on quality of life and treatment adherence in type 2 diabetes: An experimental study. Scientific Reports, 14. https://doi.org/10.1038/s41598-024-84399-9
Rubino, F., Puhl, R. M., Cummings, D. E., Eckel, R. H., Ryan, D. H., Mechanick, J. I., Nadglowski, J., Ramos Salas, X., Schauer, P. R., Twenefour, D., Apovian, C. M., Aronne, L. J., Batterham, R. L., Berthoud, H. R., Boza, C., Busetto, L., Dicker, D., De Groot, M., Eisenberg, D., Flint, S. W., et al. (2020). Joint international consensus statement for ending stigma of obesity. Nature Medicine, 26(4), 485–497. https://doi.org/10.1038/s41591-020-0803-x
Ryan, D. H., & Yockey, S. R. (2017). Weight loss and improvement in comorbidity: Differences at 5%, 10%, 15%, and over. Current Obesity Reports, 6, 187–194. https://doi.org/10.1007/s13679-017-0262-y
Sargeant, J. A., King, J. A., Yates, T., Redman, E. L., Bodicoat, D. H., et al. (2022). The effects of empagliflozin, dietary energy restriction, or both on appetite-regulatory gut peptides in individuals with type 2 diabetes and overweight or obesity: The SEESAW randomized, double-blind, placebo-controlled trial. Diabetes, Obesity and Metabolism, 24, 1509–1521. https://doi.org/10.1111/dom.14721
Sandsdal, R. M., et al. (2023). Combination of exercise and GLP-1 receptor agonist treatment reduces severity of metabolic syndrome, abdominal obesity, and inflammation: A randomized controlled trial. Cardiovascular Diabetology, 22, 41. https://doi.org/10.1186/s12933-023-01765-z
Saslow, L. R., Daubenmier, J. J., Moskowitz, J. T., Kim, S., Murphy, E. J., Phinney, S. D., et al. (2017). Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition & Diabetes, 7, 304. https://doi.org/10.1038/s41387-017-0006-9
Schabert, J., Browne, J. L., Mosely, K., & Speight, J. (2013). Social stigma in diabetes: A framework to understand a growing problem for an increasing epidemic. The Patient: Patient-Centered Outcomes Research, 6(1), 1–10. https://doi.org/10.1007/s40271-012-0001-0
Sinha, R., Papamargaritis, D., Sargeant, J. A., & Davies, M. J. (2023). Efficacy and safety of tirzepatide in type 2 diabetes and obesity management. Journal of Obesity & Metabolic Syndrome, 32(1), 25–45. https://doi.org/10.7570/jomes22067
Taylor, R. (2025). Aetiology of type 2 diabetes: An experimental medicine odyssey. Diabetologia, 68, 1375–1389. https://doi.org/10.1007/s00125-025-06428-0
Umphonsathien, M., Rattanasian, P., Lokattachariya, S., Suansawang, W., Boonyasuppayakorn, K., & Khovidhunkit, W. (2022). Effects of intermittent very-low calorie diet on glycemic control and cardiovascular risk factors in obese patients with type 2 diabetes mellitus: A randomized controlled trial. Journal of Diabetes Investigation, 13(1), 156–166. https://doi.org/10.1111/jdi.13619
Wadden, T. A., Chao, A. M., Machineni, S., Kushner, R., Ard, J., Srivastava, G., et al. (2023). Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: The SURMOUNT-3 phase 3 trial. Nature Medicine, 29, 2909–2918. https://doi.org/10.1038/s41591-023-02597-w
Yao, L., Wang, L., Zhang, R., Soukas, A. A., & Wu, L. (2024). The direct targets of metformin in diabetes and beyond. Trends in Endocrinology & Metabolism. https://doi.org/10.1016/j.tem.2024.07.017
Yılmaz, N., & Bastemir, M. (2025). Gastrointestinal adverse effects of GLP-1 and dual GLP-1/GIP receptor agonists: A comprehensive update in diabetic and obese populations. Diabetes, Metabolic Syndrome and Obesity, 19, 584175. https://doi.org/10.2147/DMSO.S584175
Yin, W., Liu, Y., Hu, H., Sun, J., Liu, Y., & Wang, Z. (2022). Telemedicine management of type 2 diabetes mellitus in obese and overweight young and middle-aged patients during COVID-19 outbreak: A single-center, prospective, randomized control study. PLOS ONE, 17, e0275251. https://doi.org/10.1371/journal.pone.0275251
Yuan, X., Wang, J., Yang, S., Gao, M., Cao, L., Li, X., Hong, D., Tian, S., & Sun, C. (2020). Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: A systematic review and meta-analysis. Nutrition & Diabetes, 10, 38. https://doi.org/10.1038/s41387-020-00142-z
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Magdalena Fąfara, Margarita Jeczkało, Monika Kosiorowska, Agata Kowalczyk, Joanna Lasoń, Marcelina Makulska, Weronika Płachta, Wiktoria Sęk, Amelia Sieradzka, Cezary Wegenko
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
