Impact of Newer Medications for Type 2 Diabetes on Body Weight

Abstract

Most patients with type 2 diabetes (T2DM) struggle with excess body weight. Many management strategies for achievement of euglycemia in T2DM are associated with weight gain, which worsens insulin resistance over time, increases health risk associated with obesity, and is associated with poor compliance with treatment. This review will discuss a host of new medications for management of hyperglycemia that have emerged and are emerging which are weight neutral, or facilitate weight loss. Incretin therapies are reviewed, including DPP-4 inhibitors which are weight neutral, and GLP-1 receptor agonists which can facilitate weight loss. SGLT-2 inhibitors, anticipated to become available soon, facilitate modest weight loss. Pramlintide can improve glycemic control and facilitate weight loss in T2DM patients on concomitant insulin therapy. The bile acid sequestering agent colesevelam, more recently approved for management of T2DM, modestly improves glycemic control and is weight neutral. The advent of these newer therapies makes it increasingly possible to optimize concomitant management of type 2 diabetes and obesity.

The Role of Hormonal Factors in Weight Loss and Recidivism after Bariatric Surgery

“…Glucagon-like peptide-1 (GLP-1) is a member of the enteroglucagon peptide family and is secreted by the L cells of the distal intestine in response to a meal [7]. Postprandial GLP-1 secretion is associated with an increase in insulin release from pancreatic beta cells while suppressing glucagon release from pancreatic alpha cells (the “incretin effect”).…”

“…Postprandial GLP-1 secretion is associated with an increase in insulin release from pancreatic beta cells while suppressing glucagon release from pancreatic alpha cells (the “incretin effect”). GLP-1 also promotes satiety both through a direct inhibitory effect on gastric emptying and a stimulatory effect on the satiety centre in the paraventricular nucleus of the hypothalamus [7]. Obese humans display an attenuated postprandial GLP-1 response compared to lean subjects, and diet induced weight loss is associated with an increase in postprandial GLP-1 release [8].…”