Timothy Garvey, MD, is a professor of medicine at the Univeristy of Alabama at Birmingham. 

W. Timothy Garvey, MD

Welcome back to Diabetes Dialogue at ADA 2025!

Diabetes Dialogue: REDEFINE 1 and REDEFINE 2, with Timothy Garvey, MD, and Melanie Davies, MD

85th Scientific Sessions of the American Diabetes Association (ADA 2025)

, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, take a deep dive into the REDEFINE 1 and REDEFINE 2 trials with trial investigators W. Timothy Garvey, MD, of University of Alabama at Birmingham, and Melanie Davies, MD, of the University of Leicester.

REDEFINE 1 was a 68-week, phase 3a trial enrolling over 3400 adults without diabetes but with obesity or overweight and at least one comorbidity. Participants received once-weekly CagriSema, semaglutide alone, cagrilintide alone, or placebo alongside lifestyle intervention.

Key outcome: CagriSema led to a mean weight loss of 20.4%, vs 3.0% with placebo.

Over 50% of participants on CagriSema reached a non-obese BMI.

Gastrointestinal side effects were common (80%), but mostly mild to moderate.

REDEFINE 2 enrolled 1206 adults with type 2 diabetes and overweight or obesity, randomized to CagriSema or placebo for 68 weeks.

Key outcome: CagriSema led to 13.7% mean weight loss, vs 3.4% with placebo.

73.5% achieved an HbA1c ≤6.5% vs 15.9% on placebo.

Significant improvements were seen across all weight loss and glycemic endpoints.

The speakers also highlight the agent’s favorable side effect profile, flexibility in real-world dosing, and benefits in body composition and physical function. Garvey emphasizes the shift toward complication-centric obesity care, underscoring the need for clinician-guided treatment beyond online prescription models.

The conversation closes with a look ahead to REDEFINE 3—a cardiovascular outcomes trial including patients with and without diabetes—and other ongoing studies in the REDEFINE and REIMAGINE trial programs.

Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others.

Relevant disclosures for Garvey include Boehringer-Ingelheim, Novo Nordisk, Eli Lilly and Company, Merck & Co., Inc., Alnylam Pharmaceuticals, Inc., Fractyl Health, Inc., Inogen, Epitomee, Pfizer Inc., and Neurovalens. Relevant disclosures for Davies include Abbie, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, GSK, Novo Nordisk, Pfizer, Regeneron, Roche, Sanofi, and Zealand Pharma.

Garvey WT, Blüher M, Osorto Contreras CK, et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity. 

Davies MJ, Bajaj HS, Broholm C. Cagrilintide–Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes. 

Podcasts

Explore groundbreaking findings from the REDEFINE trials on CagriSema's impact on weight loss and diabetes management at ADA 2025.

Counting down the biggest news from major medical meetings, it's the HCPLive Five!

HCPLive Five at Heart in Diabetes 2025

 is a medical conference bringing together world-renowned clinical leaders in 

. Designed to evaluate state-of-the-art clinical data and research while focusing on the management of the heart and 

 in diabetes, the meeting’s goal is to align cardiologists, endocrinologists, diabetologists, 

, nephrologists, and all other interested clinicians in their understanding and development of appropriate comprehensive clinical management plans for high-risk patients.

’s on-site coverage, the editorial team conducted expert interviews and reported on timely topics across implementation science, cardiometabolic health, combination therapy, and more. In this edition of the HCPLive Five, the team highlights key conversations on barriers to evidence-based cardiometabolic care, recognizing 

 as a chronic disease, data on cardiovascular disease trends, the CONFIDENCE trial of combined finerenone plus empagliflozin in patients with both 

 and type 2 diabetes, and data accessibility issues in an era of unprecedented technological innovation.

Improving Evidence-Based Cardiometabolic Care, with Neha Pagidipati, MD, MPH

While innovation in cardiovascular, kidney, and metabolic care often centers around emerging therapies, the underuse of established, evidence-based treatments in clinical practice remains a major and under-discussed challenge. In this interview with 

 at HiD, Neha Pagidipati, MD, MPH, an assistant professor of medicine and cardiovascular disease prevention specialist at Duke University School of Medicine, reviews different barriers to implementing guideline-directed medical therapy as well as facilitators and potential avenues for improvement moving forward.

Classifying Obesity as a Chronic Disease with W. Timothy Garvey, MD

Given the limitations surrounding BMI measurement of obesity, a recent Lancet Commission aimed to better define obesity as a condition of illness that comes as a direct result of excess adiposity and its effect on the function of tissues and organs. In this interview with 

 at HiD, Timothy Garvey, MD, breaks down some of the key points from the paper and how they will influence the treatment of obesity and its complications moving forward.

Moving the Needle on Cardiovascular Disease, with Seth Martin, MD, MHS

Despite decades of progress and innovation in cardiovascular care, recent data from the American Heart Association (AHA) suggest that the momentum has stalled—and in some cases, reversed. At HiD, Seth Martin, MD, MHS, a professor of medicine in the division of cardiology at Johns Hopkins Hospital and co-founder at Corrie Health, offered a data-driven overview of the current state of cardiovascular disease (CVD) in the United States and globally, based on the AHA’s 2024 statistical update. In this interview with 

, he reviews key trends and calls for urgent action to improve implementation of prevention and treatment strategies at scale.

Don’t Miss a Beat: CONFIDENCE Trial and Combination T2D, CKD Therapy at Heart in Diabetes 2025

, hosts Muthiah Vaduganathan, MD, MPH, a cardiologist and codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women’s Hospital, and Steve Greene, MD, an advanced heart failure specialist at Duke University School of Medicine, review key findings and clinical implications of the CONFIDENCE trial. The data, which were also presented at the 

62nd European Renal Association (ERA 2025) Congress

 in Vienna, Austria, suggest the potential benefits of combination initial therapy with finerenone plus empagliflozin in patients with both CKD and type 2 diabetes.

Confronting Cardiology's Data Accessibility Problem, with Robert Califf, MD

, Robert Califf, MD, an instructor of medicine at Duke University School of Medicine and former commissioner of the US Food and Drug Administration, provided his perspective on the ongoing difficulties in implementation of digital technologies and preventative measures for cardiovascular diseases and diabetes. He points to shortcomings of the cardiology field and the medical industry at large in adapting technological advances to practical, clinical usability, citing the high number of new programs and mechanisms for tracking individual risk factors and their failure to collate this data meaningfully for patients.

These 5 represent only some of the data the 

 team covered at this year's meeting! Check out more KOL insight and our full conference coverage on our 

Videos

From barriers to implementing evidence-based care to innovations in combination therapy, here are 5 key updates from the annual meeting.

 in Philadelphia, PA, W. Timothy Garvey, MD, professor and university professor, Department of Nutrition Sciences, University of Alabama in Birmingham and director of UAB Diabetes Research Center in Birmingham, Alabama, presented the results of the Lancet Commission on Obesity and how these findings will influence the treatment of 

Given the limitations surrounding BMI measurement of obesity, the Lancet Commission aimed to better define obesity as a condition of illness that comes as a direct result of excess adiposity and its effect on the function of tissues and organs. The Commission initially intended to establish specific criteria for diagnosis, thereby facilitating further therapeutic interventions and public health strategies.

Garvey spoke on several of the contributions he believed were made by the Commission during the process, namely the indication of the various complications of obesity that were used to qualify it as a disease. He noted lymphedema, intracranial pressure, 

heart failure with preserved ejection fraction

, and arterial pressure, among others, as being directly caused by excess adiposity.

“These are complications that are integral to the state of excess adiposity,” Garvey told 

. “And what stronger statement is there that obesity is a disease when you can link it to these types of changes in function and structure of organs that produce symptoms?”

Garvey also spoke on the Commission’s development of a separate category of obesity-related diseases. These were described as diseases whose pathophysiology can overlap with the defined components of obesity. He gave the example of 

“So, on the obesity side, you have obesity-induced insulin resistance, but patients have to have a decreased insulin secretory capacity in order to produce hyperglycemia and overt diabetes,” Garvey said. “It required a defect in insulin secretion as well as obesity-induced insulin resistance. So that’s an example of an obesity-related disease.”

Notably, one of the Commission’s core decisions proved to be rather controversial in the medical sphere. Garvey expounded on this, explaining the difference drawn between preclinical and clinical obesity as defined by the Lancet Commission. This decision separated the notion of obesity as a risk factor from the actual diseases it can facilitate, establishing it as a disease in its own right.

“Well, preclinical obesity is a state of excess adiposity without complications,” Garvey told 

. “Patients can be active, they feel fine, they can be exercising every day, be productive individuals in society, even though they have excess body weight. It is a state of increased risk.”

Garvey noted that preclinical obesity still requires evaluation, counseling, and eventually some form of intervention, given that it could progress to clinical obesity at any time. However, Garvey did state that not all patients with preclinical obesity need aggressive therapies in the same way as patients with clinical obesity.

“If you have complications or obesity-related diseases, that tells you that the adiposity that’s presented is harming the health of the person, and now therapy is clearly warranted – medication, bariatric surgery, lifestyle intervention, etc,” Garvey said. “We treat the disease with weight loss, not just to lose X amount of pounds, but to achieve sufficient weight loss to prevent or treat the complications that might arise.”

Garvey expressed his interest in the studies that have been undertaken in response to the Commission. He hopes that the field is moving in the direction of preventative measures and treatment, given the new mentality of obesity as a chronic disease.

“I think we’ve seen this complication-centric approach to care is now being integrated into phase 3 development programs for new pharmaceutical medications,” Garvey said. “I think that’s where the field is going, and I think it’s a good thing we’re now treating obesity as a disease. Obesity is now on par with the way we treat other chronic diseases as well.”

Garvey reports the following disclosures: Boehringer-Ingelheim, Novo Nordisk, Eli Lilly, Merck & Co., Inc., Neurovalens, Fractyl Health, Inc., and others.

Garvey W. The Lancet Commission on Obesity. Presented at the 9

 Annual Heart in Diabetes Conference in Philadelphia, PA, June 6-8, 2025.

Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity [published correction appears in Lancet Diabetes Endocrinol. 2025 Mar;13(3):e6. doi: 10.1016/S2213-8587(25)00006-3.]. Lancet Diabetes Endocrinol. 2025;13(3):221-262. doi:10.1016/S2213-8587(24)00316-4

The recent Lancet Commission on Obesity has repositioned the former risk factor as a disease, indicating and emphasizing a variety of complications.

W. Timothy Garvey, MD

Articles