Gorgojo-Martínez Juan J
Department of Endocrinology and Nutrition, Hospital Universitario Fundación Alcorcón, C/Budapest 1, 28922 Alcorcón, Spain.
J Clin Med. 2025 Jan 21;14(3):678. doi: 10.3390/jcm14030678.
The global prevalence of obesity and type 2 diabetes mellitus (T2D) has risen in parallel over recent decades. Most individuals diagnosed with T2D exhibit adiposopathy-related diabetes (ARD), a condition characterized by hyperglycemia accompanied by three core features: increased ectopic and visceral fat deposition, dysregulated adipokine secretion favoring a pro-inflammatory state, and insulin resistance. Despite advancements in precision medicine, international guidelines for T2D continue to prioritize individualized therapeutic approaches focused on glycemic control and complications, and many healthcare providers predominantly maintain a glucocentric strategy. This review advocates for an adipocentric treatment paradigm for most individuals with T2D, emphasizing the importance of prioritizing weight loss and visceral fat reduction as key drivers of therapeutic intensification. By combining lifestyle modifications with pharmacological agents that promote weight loss-including SGLT-2 inhibitors, GLP-1 receptor agonists, or dual GLP-1/GIP receptor agonists-and, when appropriate, metabolic surgery, this approach offers the potential for disease remission in patients with shorter disease duration. For others, it enables superior metabolic control compared to traditional glucose-centered strategies while simultaneously delivering cardiovascular and renal benefits. In conclusion, an adipocentric treatment framework for ARD, which represents the majority of T2D cases, effectively integrates glucocentric and cardio-nephrocentric goals. This approach constitutes the optimal strategy for ARD due to its efficacy in achieving disease remission, improving metabolic control, addressing obesity-related comorbidities, and reducing cardiovascular and renal morbidity and mortality.
近几十年来，全球肥胖症和2型糖尿病（T2D）的患病率呈平行上升趋势。大多数被诊断为T2D的个体表现出与脂肪病相关的糖尿病（ARD），这是一种以高血糖为特征的病症，伴有三个核心特征：异位和内脏脂肪沉积增加、脂肪因子分泌失调导致促炎状态以及胰岛素抵抗。尽管精准医学取得了进展，但T2D的国际指南仍继续优先考虑以个体化治疗方法为主，重点关注血糖控制和并发症，许多医疗保健提供者主要维持以血糖为中心的策略。本综述主张对大多数T2D患者采用以脂肪为中心的治疗模式，强调将减肥和减少内脏脂肪作为强化治疗的关键驱动因素的重要性。通过将生活方式改变与促进减肥的药物（包括钠-葡萄糖协同转运蛋白2抑制剂、胰高血糖素样肽-1受体激动剂或双胰高血糖素样肽-1/葡萄糖依赖性促胰岛素多肽受体激动剂）相结合，并在适当情况下进行代谢手术，这种方法为病程较短的患者提供了疾病缓解的可能性。对于其他患者，与传统的以葡萄糖为中心的策略相比，它能实现更好的代谢控制，同时带来心血管和肾脏方面的益处。总之，针对代表大多数T2D病例的ARD的以脂肪为中心的治疗框架有效地整合了以血糖为中心和以心肾为中心的目标。由于其在实现疾病缓解、改善代谢控制、解决肥胖相关合并症以及降低心血管和肾脏发病率及死亡率方面的功效，这种方法构成了ARD的最佳策略。
