Anti-diabetic Treatment in Obese Patients with Type 2 Diabetes Effects of Medication on Body Weight

Anti-diabetic Treatment in Obese Patients with Type 2 Diabetes Effects of Medication on Body Weight

Andrew J Krentz
US Endocrine Disease 2006 Issue 2
Published: October 2008
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Obesity is a major risk factor for the development of type 2 diabetes;1–3 moreover, the presence of obesity in type 2 diabetes is associated with an increased risk of vascular complications associated with the disorder.4,5 The majority of patients are overweight or obese at diagnosis of type 2 diabetes. Recent clinical trials have demonstrated that progression to diabetes in obese patients with impaired glucose tolerance can be prevented through weight reduction and increased levels of physical activity.6,7 For patients who have developed type 2 diabetes, intentional weight loss has many potential benefits including improved metabolic control and a reduced need for antidiabetic medications.8–10

One of the challenges of using anti-diabetic therapy in obese or overweight patients is the prospect of substantial iatrogenic weight gain with many widely used drug classes. Since lifestyle interventions including weight loss are usually very difficult to achieve and/or sustain, the practitioner frequently is left with few options when trying to avoid adverse effects of antidiabetic therapy that are counterproductive to efforts directed at weight loss.

New classes of anti-diabetic agents mimic or potentiate the activities of incretin hormones, including the injectable glucagon-like peptide-1 (GLP-1) mimetics and the oral dipeptidyl peptidase- 4 (DPP-4) inhibitors. These drugs have benefits for glucose-dependent insulin secretion, suppression of glucagon secretion, inhibition of gastric emptying, and appetite reduction.11–14 They are effective in lowering glycosylated hemoglobin (HbA1c) and are associated with either weight loss (GLP-1 mimetics) or weight neutrality (oral DPP-4 inhibitors). Thus, these drugs promise to be useful in obese/overweight patients with type 2 diabetes.

A new anti-obesity agent, the selective cannabinoid receptor antagonist rimonabant, is effective in reducing weight and improving a range of metabolic defects in patients with type 2 diabetes. Such new agents should improve our ability to treat overweight or obese patients.

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