Weight-Loss Drugs Important in Type 2 Diabetes Management

Optimizing weight "should be a priority" in the management of patients with type 2 diabetes….

First author Dr. Luigi F. Meneghini, director of the Kosow Diabetes Treatment Center at the University of Miami Miller School of Medicine stated that, "Today’s options for diabetes management include therapies that allow improvement in glycemic control while minimizing the risk of weight gain."

"From GLP-1 (glucagon-like peptide-1) receptor agonists that can promote weight loss, to DPP-4 (dipeptidyl peptidase-4) inhibitors and metformin, which do not produce weight gain, our therapeutic armamentarium is growing," he added.

In their paper, Dr. Meneghini and colleagues review "weight-friendly" pharmacotherapies for type 2 diabetes and suggest glucose-lowering strategies that mitigate weight gain and its potential negative impact on glycemic control, cardiovascular disease, and other health outcomes.

Their focused review, they note, included a "comprehensive selection of representative clinical trials" covering all agents with data available to report weight change in patients with type 2 diabetes.

The findings, the authors say, reaffirm the weight benefits of metformin, with several trials suggesting a weight reduction of 0.6 to 2.9 kg (1.3 to 6.4 lbs) when used as monotherapy in treatment-naive adults.

Of the "newer" available agents, GLP-1 agonists and amylin analogs promote weight loss, while DPP-4 inhibitors, bile acid sequestrants, and carbohydrate inhibitors tend to be weight-neutral, they note.

The researchers propose the following strategy based on potential weight benefit and blood glucose increment.

• For patients with elevated fasting plasma glucose: long-acting GLP-1 agonists (liraglutide), DPP-4 inhibitors, bile acid sequestrants, amylin analogs, and basal insulin.
• For patients with elevated postprandial glucose: short-acting (exenatide) or long-acting GLP-1 agonists, amylin analogs, DPP-4 inhibitors, acarbose, and bile acid sequestrants.

They also suggest that the weight-sparing effects of insulin detemir, notably in patients with high body mass index, be considered when initiating insulin therapy, "because these patients can least afford to incur further weight gain."

"Physicians are increasingly familiar with treatment strategies that provide benefit while minimizing the traditional down sides of therapy such as weight gain and hypoglycemia risk," Dr. Meneghini noted.

Published online before print September 7, 2011, doi: 10.1210/jc.2011-1074 The Journal of Clinical Endocrinology & Metabolism September 7, 2011 jc.2011-1074