Type 2 Diabetes Differs Across Weight Profiles, Study Challenges One-Size-Fits-All Approach - Video

Type 2 diabetes may develop through two fundamentally different biological pathways depending on a person's body weight, suggesting that treatment could eventually need to be tailored to the underlying cause rather than using the same approach for everyone, according to a study published in Diabetologia.

Researchers from Amsterdam UMC and the University of Ghana analyzed data from more than 3,300 adults with type 2 diabetes to examine how body composition relates to the mechanisms behind the disease.

The study found that in people with a higher BMI, type 2 diabetes was primarily driven by insulin resistance, in which the body's cells become less responsive to insulin. In people with a lower BMI, however, diabetes was more often linked to the pancreas producing insufficient insulin.

Despite these differences, patients are generally treated with similar medications, including drugs such as metformin and sulfonylureas. Researchers say treatments that primarily target insulin resistance may be less effective for people whose diabetes is driven mainly by inadequate insulin production.

The findings also revealed differences in diabetes-related complications. People with lower BMI were more likely to experience diabetic retinopathy and stroke, while those with higher BMI more often had high blood pressure and cardiovascular disease. Chronic kidney disease occurred at similar rates across the groups. Researchers found that body fat explained much of the variation in these outcomes, supporting the possibility that type 2 diabetes may represent biologically distinct forms rather than a single disease process.

The study also highlights factors beyond excess weight that may contribute to diabetes. Researchers noted that experiences such as malnutrition or low birth weight may affect pancreatic development and the body's ability to produce insulin later in life.

The researchers are calling for targeted clinical trials to determine whether treatments should be selected according to the biological mechanism driving diabetes. They emphasize that more research is needed before changes to current treatment guidelines can be recommended.

REFERENCE: Esmail, S., Hayfron-Benjamin, C., Darko, S.N. et al. Divergent complication patterns of type 2 diabetes in African individuals who are lean versus overweight or obese: a multi-cohort analysis. Diabetologia (2026). https://doi.org/10.1007/s00125-026-06830-2