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Different patterns of body fat can protect against, or increase risk of, type 2 diabetes

A new Diabetes UK-funded study has shed new light on the links between body weight and type 2 diabetes, identifying patterns of body fat that can put some people more at risk of developing the condition than others.

The findings help us understand why people of similar body weights can have such different risks of type 2 diabetes, and could help to personalise the way we prevent or treat the condition. 

Type 2 diabetes is complex and is influenced by a mix of drivers including bodyweight, along with factors like genetics, age and ethnicity. The majority of people who live with overweight or obesity do not develop type 2 diabetes.

With our funding, Dr Hanieh Yaghootkar from the University of Lincoln studied genetic information and measures of body fat from thousands of people to better understand why higher body weight doesn’t always equal higher type 2 diabetes risk.

She identified combinations of genes that influence body fat type and where it is stored in distinct ways. 

Protective body fat

Dr Yaghootkar found that having higher body fat can increase the risk of type 2 diabetes due to factors including inflammation and higher cholesterol. But she also found evidence for two main ways by which higher body fat could reduce the risk of type 2 diabetes.

The first way involved having more fat stored under the skin, with lower levels of liver fat and better insulin sensitivity. The liver plays a crucial role in maintaining blood sugar levels and to function well it should contain little or no fat. This body type was also linked with a lower risk of diabetes complications.

The second protective mechanism involved a larger body size, coupled with better muscle quality.

These insights show that not all body fat affects health in the same way. Understanding these differences could help to develop more specific advice for managing body fat and reducing the risk of type 2 diabetes.

Dr Hanieh Yaghootkar said: 

“Our findings underscore the complex nature of relationship between obesity and type 2 diabetes and help explain why individuals with similar levels of body fat can have vastly different risks of developing cardiometabolic diseases like type 2 diabetes. 

“By identifying specific mechanisms and subtypes of adiposity, it is possible to inform more effective precision medicine strategies. This might lead to more targeted approaches to managing type 2 diabetes and related conditions, which could ultimately improve patient outcomes.”

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:

“This research takes us a step closer to understanding the genetic reasons why some people living with obesity or overweight develop type 2 diabetes and why others are naturally protected.  

“Early and accurate identification of those who are at greater risk of type 2 diabetes could help improve the way we predict, prevent and treat the condition.

“It’s important to remember that type 2 diabetes is a complex condition with many risk factors and that people with a genetic susceptibility to type 2 diabetes can still take steps to reduce their risk, including by losing weight to reduce levels of fat in their liver.”

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