Treating Obesity to Fight Type 2 Diabetes

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Obesity per se is not necessarily the kind of problem that we as physicians would categorize as a disease, because it's difficult to show that other than some of the physical factors, if you will, and the reduced mobility and some propensity to musculoskeletal disorders disorders, clear cut change in longevity actually comes from the fact that it's driving type 2 diabetes, largely.

If you treat a diabetic of, let's say, after a heart attack or even with heart failure, the efficacy of that treatment is reduced compared to the non diabetic. In other words, our standard therapies for heart and vascular disease are not working as well. And that is because we don't understand this rather unique form of heart and vascular disease that occurs in the context of diabetes.

And so it will be very helpful for us and we are doing this and other people are doing these studies to understand a little bit more about the genome of these individuals because it's probably not going to be a single aha moment with a mutation in one gene, but there will be variations that come together that probably protect these individuals, and we would like to look and see, if we look at those individuals and compare them to those who develop heart disease with only a modest increase in obesity or insulin resistance in diabetes rapidly with obesity, that we would compare those, so that might be an opportunity for the genomic approach. There are several new medications coming out, they're just down the horizon that will reduce the appetite.

And so one approach in the future that we should look at are appetite reducing medications. We need, also if you will, a one two punch for this problem which would be reducing appetite and increasing peripheral energy expenditure, if you will, an exercise and a pill. We are only beginning to understand that changes in I'll just use the term metabolism but the ability of the body not only to utilize the food stuff that come in as fuel but also to turn it into building blocks is deranged, obviously, in obesity and diabetes, and some of those derangements, we are learning based in laboratory studies, are capable of driving heart failure and heart disease.

So there is a really vicious interplay between first, our propensity in general in the nation to develop heart and vascular disease, but when you put the metabolic disturbances upon that, then we have to treat, we believe, the metabolic disturbances.