Inflammation is an important link between obesity, elevated blood sugar, and type 2 diabetes.
Weight loss can reduce inflammation—a major contributor to diabetes.
We’ve known for a long time that being overweight is a major risk factor for developing type 2 diabetes. But only in the last 20 years have researchers determined that metabolism and immune responses are linked and that chronic inflammation plays an important role in the development of obesity, diabetes, and related metabolic diseases. “Inflammation is not only associated with obesity, diabetes, and cardiovascular disease, but also precedes and predicts these conditions,” says Dr. Allison Goldfine, head of the Clinical Research section at Harvard-affiliated Joslin Diabetes Center.
Dr. Goldfine works closely with scientists who explore the mechanisms of diabetes in the laboratory and develops ways to translate their discoveries to prevent and treat diabetes in humans. One such discovery came in the 1990s, when scientists determined that body fat is more than an inert storage system; it produces both helpful and harmful substances. For example, fat cells not only release adiponectin, a hormone that is involved in glucose control, but also a host of molecules that trigger inflammation. Additional research over the last two decades has suggested that inflammation slows metabolism and increases the risk of developing diabetes.
Lowering blood sugar by reducing inflammation
In a study reported in 2013, Dr. Goldfine and colleagues tested salsalate (Disalcid)—a prescription anti-inflammatory drug used to treat arthritis—in 286 people with type 2 diabetes whose blood glucose was inadequately controlled by the medications they were taking. Participants were randomly assigned to salsalate and placebo groups. They also continued to take their current medications. After 48 weeks of treatment, the aver-age level of hemoglobin A1c—a measurement of blood glucose control over several weeks—was significantly lower in the salsalate group compared with the placebo group. Moreover, compared with the placebo group, the people taking salsalate had a 15 milligrams per deciliter greater decrease in fasting glucose concentration and required fewer additional drugs to control their blood sugar. The salsalate group also had a 27% increase in adiponectin.
Although this research indicates that anti-inflammatory drugs may help to prevent diabetes, it doesn’t mean that you should reach for the aspirin or ibuprofen to keep inflammation at bay. Salsalate was used in the study because it has a different mechanism of action and is safer to take for longer periods than most available non-steroidal anti-inflammatory drugs (NSAIDs). However, while promising, neither salsalate nor any other NSAIDs have been approved for diabetes control or prevention.
Losing weight to reduce inflammation
A growing body of research indicates that weight loss alone will reduce inflammation. If your body mass index (BMI) is over 30, you may want to work with your primary care team to set goals and develop a program to reach them. The National Diabetes Prevention Program, offered online and at health centers throughout the country, can help you achieve lifestyle changes (see www.cdc.gov/diabetes). Weight- loss medication and bariatric surgery may also be options.
If your BMI is in the range of 25 to 30, exercising regularly and following a healthy eating pattern can control your weight, your blood sugar, blood pressure, and cholesterol levels—and reduce inflammation in the bargain. There is some evidence that an eating pattern that emphasizes vegetables, fruits, whole grains, vegetable oils, seafood, and nuts and seeds and minimizes sugar, red meat, and processed foods may have the greatest inflammation-fighting effect.