Obesity has been recognized as one of the core therapeutic targets in type 2 diabetes mellitus (T2DM).Professor Andreas Liebl emphasizes that weight control itself is an independent therapeutic goal.However, given limited medical resources, it is essential to define priority populations.In his view, the following patient groups should receive prioritized intervention:
First group: Early‑stage diabetes patients with overweight or obesity.For these patients, successful weight loss may lead to diabetes remission or partial remission.Early weight control not only improves diabetes but can ultimately prevent diabetic complications
Second group: Obese diabetes patients with established microvascular or cardiovascular complications.This population benefits from GLP‑1 receptor agonists and GIP/GLP‑1 dual receptor agonists,which improve glycemic control and body weight while providing secondary cardiovascular prevention.
Third group: Obese T2DM patients with weight‑sensitive comorbidities,such as obstructive sleep apnea (OSA), non‑alcoholic fatty liver disease (NAFLD), non‑alcoholic steatohepatitis (NASH), and heart failure.Studies have confirmed that dual receptor agonists and semaglutide reduce disease risk in patients with OSA.
Fourth group: Insulin‑treated T2DM patients.This represents a large subgroup, in whom insulin therapy often causes weight gain.Increased weight further raises insulin requirements, creating a vicious cycle:weight gain → higher insulin doses.Weight loss effectively breaks this cycle, reduces insulin dosage, and simplifies disease management.
In practice, we are increasingly successful in matching the right therapy to the right patient,gradually advancing toward precision medicine.Although we have not yet reached the ideal state, the overall direction is correct.Moreover, we are becoming better at identifying specific patient subgroupsthat will gain the most benefit from our treatment strategies.