Weight Management in Type 2 Diabetes: Current and Emerging Approaches to Treatment

Abstract

Diabetes is a growing global health concern, as is obesity. Diabetes and obesity are intrinsically linked: obesity increases the risk of diabetes and also contributes to disease progression and cardiovascular disease. Although the benefits of weight loss in the prevention of diabetes and as a critical component of managing the condition are well established, weight reduction remains challenging for individuals with type 2 diabetes due to a host of metabolic and psychological factors. For many patients, lifestyle intervention is not enough to achieve weight loss, and alternative options, such as pharmacotherapy, need to be considered. However, many traditional glucose-lowering medications may lead to weight gain. This article focuses on the potential of currently available pharmacological strategies and on emerging approaches in development to support the glycemic and weight-loss goals of individuals with type 2 diabetes. Two pharmacotherapy types are considered: those developed primarily for blood glucose control that have a favorable effect on body weight and those developed primarily to induce weight loss that have a favorable effect on blood glucose control. Finally, the potential of combination therapies for the management of obese patients with type 2 diabetes is discussed.

Effects of once‐weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity

“…GLP‐1 receptor agonists (RAs) have been shown to reduce body weight and blood glucose levels in people who are overweight or obese, with or without diabetes 6, 7, 8, 9, 10. Furthermore, activation of GLP‐1 receptors in the human brain helps to regulate appetite and food reward 11.…”

Canagliflozin: A Review in Type 2 Diabetes

“…sulfonylureas, meglitinides, thiazolidinediones and insulin) or being bodyweight neutral (e.g. DPP4 inhibitors, metformin, α-glucosidase inhibitors) [2,85]; as such, canagliflozin has a bodyweight profile more favourable than that of glimepiride or sitagliptin as an add-on therapy (Sect. 4.2).…”

Review of the Pharmacological and Bariatric Surgery for Diabesity

“…Selective stimulation of 5HT2C which regulates appetite and promotes satiety [6] Fatigue, dizziness, nausea and headaches [13] 3% weight loss [13], 2014) 3kg [7] 37-47% [13] Sympathomimetic amine anorectic/antiepileptic combination Phentermine Targets hypothalamus to Stimulate adrenal glands to release noradrenaline which regulates appetite and promotes satiety [6] Insomnia, irritability [13] 9% weight loss [13] 67-70% [13] plus Toprimate Antiepileptic drug works on multiple cellular levels-unknown how this reduces weight [6] Opioid antagonist/ aminoketone antidepressant combination (Naltrexone /bupropion)…”

“…Moderate and maintained weight loss has been demonstrated to be effective in lowering glycaemic levels in obese people with T2DM as well as reducing the need for oral hypoglycaemic medications [7]. T2DM guidelines recommend lifestyle interventions as first line management for obesity yet despite the evidence that lifestyle modifications can elicit 5-10% weight loss [8] and have clinically significant benefits in the management of T2DM many patients are unable to accomplish or sustain this in the long term [6]. This review will explore the evidence for pharmacological and surgical management for obesity in T2DM.…”

“…The definition of obesity according to the World Health Organization is "a condition in which percentage body fat (PBF) is increased to an extent in which health and well-being are impaired" [2], as is the case in T2DM where obesity compounds disease progression [3,4]. Obesity contributes to insulin resistance [5], and as such addressing obesity is a vital aspect in the management of T2DM [6]. Moderate and maintained weight loss has been demonstrated to be effective in lowering glycaemic levels in obese people with T2DM as well as reducing the need for oral hypoglycaemic medications [7].…”