It is well established that the incidences of type 2 diabetes and impaired glucose tolerance are very low at ideal body weight (body mass index [BMI] 21—22 kg/m2) but increases with increasing body fat and BMI. Adipose tissue is an active endocrine organ which secretes many hormones involved in the regulation of body weight and appetite, including leptin and tumour necrosis factor-alpha, which are related to diabetes development. Weight loss is an important goal within the overall management of diabetes, and recent intervention trials have established that the benefits of weight loss may extend to the prevention of diabetes itself. Weight loss associated with diet and exercise in the DPP and the FDPS, by the anti-obesity drug orlistat in the XENDOS trial, and by gastric surgery in the SOS study all significantly reduced the incidence of diabetes compared with controls. The prevention or reversal of obesity is therefore an increasingly important therapeutic target in the prevention of type 2 diabetes.
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