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Minimizing Weight Gain

Oct 28, 2017

A 43-year-old patient with a 2-year history of type 2 diabetes presents to your office for a follow-up visit. She is a highly motivated patient and doesn’t have any significant co-morbidities, so together, you have set a target A1C= 6.5%. Her current medications are metformin and sulfonylurea. Despite her good efforts, her current A1C is 7.3%. You would like to add a third agent to her regimen, however, she is concerned about any additional weight gain as she has gained a few pounds since starting the sulfonylurea. Which drug class would you add to minimize any additional weight gain?


Correct Answer is: B. GLP-1 agonist

Educational Critique: The use of GLP-1 receptor agonist is associated with weight loss. Metformin is considered to be weight neutral and can also be associated with weight loss. DPP-4 inhibitors are considered weight neutral and the sulfonylureas, meglitinides and thiazolidinedione are associated with weight gain. All insulin and insulin analogues can lead to weight gain. However, both insulin analogue detemir and insulin analogue glargine have been associated with less weight gain, compared to NPH, when used as basal insulin. Detemir causes the least amount of weight gain, followed by glargine. The mechanism for this is still not clearly understood. One 6-month study in individuals with type 2 diabetes receiving basal–bolus therapy found insulin detemir was associated with a 0.4 kg weight gain vs 1.3 kg weight gain in patients receiving NPH insulin. A 24-week comparison of either NPH insulin or insulin detemir as an add-on therapy to oral agents in type 2 diabetes found detemir was associated with a mean weight gain of 1.2 kg vs. NPH insulin mean weight gain of 2.8 kg. -- Diabetol Metab Syndr. 2013; 5: 56.