Diabetes and Drugs: The Weight Loss Dilemma

In 2015, 30.3 million people in the United States 9.4% of the population had diagnoses of diabetes. Type 1 diabetes is the primary diagnosis for 1.25 million Americans. Type 2 diabetes is likely highly underreported.

Obesity is a major cause of type 2 diabetes. Lifestyle changes and weight loss can delay type 2 diabetes development and decrease risk of complications. Weight can be a difficult topic for patients, as people with diabetes often have trouble losing weight and medications can cause weight gain.

An article published in Diabetologia explores how various drugs used to treat diabetes affect obesity and weight loss/management. The authors reported 3 key findings:

■Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are glucose lowering drugs that may result in weight loss.

■Weight neutral treatments include metformin, alpha-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors (DP-IVi).

■Treatment with sulfonylureas, glinides, thiazolidinediones, and insulin often result in weight gain.

Clinicians sometimes prescribe obesity treatment drugs with lifestyle management. Clinicians should generally consider this category of medications for patients with BMI exceeding 30 kg/m³ or for patients with BMI exceeding 27 kg/m³ who have type 2 diabetes or other severe comorbidities such as type 2 diabetes.

The FDA has approved orlistat (an intestinal lipase inhibitor), liraglutide (a GLP-1 RA), lorcaserin (a 5-hydroxytryptamine_2C serotonin receptor agonist), combination treatment of phentermine (centrally acting sympathomimetic) plus topiramate, and combination treatment of naltrexone (µ-opioid antagonist) plus bupropion (noradrenaline and dopamine reuptake inhibitor) as pharmacologic weight loss treatments in the United States. These options may help people who have diabetes and are trying to lose weight.

Researchers are developing novel treatments to support weight management, though limited data supports their use in diabetes. Most treatments under investigation work by decreasing food intake.

Many people with type 1 diabetes are obese and intensive insulin treatment can promote weight gain. Trials of treatments associated with weight loss that have enrolled patients who have type 1 diabetes have not produced evidence to support their use. Trials of obesity drugs in type 1 diabetes patients have not been conducted.

Reference

Wilding JPH. Medication use for the treatment of diabetes in obese individuals. Diabetologia; doi 10.1007/s00125-017-4288-1.