Weight loss effects of diabetes medications
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Weight Loss Effects of Diabetes Medications: Overview
Many diabetes medications have different effects on body weight, which is important for people with diabetes, especially those who are overweight or obese. Some medications help with weight loss, some are weight-neutral, and others can cause weight gain. Choosing the right medication can help improve both blood sugar control and weight management 1258910.
Medications That Promote Weight Loss in Diabetes
GLP-1 Receptor Agonists and Dual Agonists
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as liraglutide, semaglutide, and exenatide, as well as the dual agonist tirzepatide, are among the most effective diabetes medications for weight loss. Liraglutide, semaglutide, and tirzepatide can lead to strong weight loss, often greater than 5% of initial body weight, with tirzepatide showing the highest reductions in some studies 124. Semaglutide and tirzepatide have also shown significant weight loss in people with type 1 diabetes, with tirzepatide leading to over 20% body weight loss in some cases . Exenatide, another GLP-1 RA, tends to result in mild weight loss .
SGLT2 Inhibitors
Sodium-glucose cotransporter 2 inhibitors (SGLT2i), such as canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin, also promote weight loss. Canagliflozin, especially at higher doses, leads to the most weight loss among SGLT2 inhibitors, with average reductions of up to 3 kg or more 1236. Empagliflozin has been shown to reduce weight, BMI, and waist circumference by about 3-4% over three months . SGLT2 inhibitors generally provide moderate weight loss (3.2% to 5% of initial weight) 13.
Metformin and Acarbose
Metformin and acarbose are associated with mild weight loss, usually less than 3.2% of initial body weight 1210. These medications are often considered first-line treatments for type 2 diabetes, partly because of their favorable weight profile 1210.
Medications That Are Weight Neutral or Cause Weight Gain
Dipeptidyl peptidase-4 (DPP-4) inhibitors are generally weight-neutral or may cause only mild weight loss 210. In contrast, medications such as insulin, sulfonylureas, thiazolidinediones, and meglitinides are associated with weight gain, which can be a challenge for people trying to lose weight 578910.
Real-World and Programmatic Evidence
Even when people use diabetes medications that are typically associated with weight gain, structured lifestyle and digital therapeutics programs can still help achieve weight loss and improved blood sugar control . This suggests that combining medication with lifestyle support is important for effective weight management in diabetes 78.
Clinical Implications and Recommendations
When choosing diabetes medications for people who are overweight or obese, it is important to consider the effects on body weight. GLP-1 RAs, SGLT2 inhibitors, metformin, and acarbose are preferred for their weight loss benefits, while medications that cause weight gain should be used cautiously in these patients 1258910. Combining weight-loss-promoting medications with lifestyle interventions can further enhance outcomes 78.
Conclusion
Some diabetes medications, especially GLP-1 receptor agonists, dual agonists like tirzepatide, and SGLT2 inhibitors, are effective for weight loss in people with diabetes. Metformin and acarbose offer mild benefits, while DPP-4 inhibitors are mostly weight-neutral. Medications such as insulin and sulfonylureas can cause weight gain. Considering the weight effects of diabetes medications is crucial for optimizing both blood sugar control and overall health in people with diabetes.
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