The association between diabetes medication and weight change in a non‐surgical weight management intervention: an intervention cohort study

Abstract

Aim To compare weight change in a lifestyle-based weight management programme between participants taking weight-gaining, weight-neutral/loss and mixed diabetes medications.Methods Electronic health records for individuals (≥ 18 years) with Type 2 diabetes who had been referred to a nonsurgical weight management programme between February 2008 and May 2014 were studied. Diabetes medications were classified into three categories based on their effect on body weight. In this intervention cohort study, weight change was calculated for participants attending two or more sessions.Results All 998 individuals who took oral diabetes medications and attended two or more sessions of weight management were included. Some 59.5% of participants were women, and participants had a mean BMI of 41.1 kg/m 2 (women) and 40.2 kg/m 2 (men). Of the diabetes medication combinations prescribed, 46.0% were weight-neutral/loss, 41.3% mixed and 12.7% weight-gaining. The mean weight change for participants on weight-gaining and weightneutral/loss diabetes medications respectively was À2.5 kg [95% confidence interval (CI) À3.2 to À1.8) and À3.3 kg (95% CI À3.8 to À2.9) (P = 0.05) for those attending two or more sessions (n = 998). Compared with those prescribed weight-neutral medications, participants prescribed weight-gaining medication lost 0.86 kg less (95% CI 0.02 to 1.7; P = 0.045) in a model adjusted for age, sex, BMI and socio-economic status.Conclusions Participants on weight-neutral/loss diabetes medications had a greater absolute weight loss within a weight management intervention compared with those on weight-gaining medications. Diabetes medications should be reviewed ahead of planned weight-loss interventions to help ensure maximal effectiveness of the intervention.

Class 3 Obesity in a Multidisciplinary Metabolic Weight Management Program: The Effect of Preexisting Type 2 Diabetes on 6-Month Weight Loss

“…This study adds more support for prescribing weight-neutral/losing diabetes medications to patients with class 3 obesity in medical programs for weight loss. Aldekhail et al showed that patients with T2DM prescribed a weight-neutral/losing medication lost more weight than those prescribed weight-gaining medication [ 30 ]. Our study supports this finding although we showed that changing to weight-neutral/losing medications during the program was associated with more weight loss than changing to weight-gaining medications.…”

“…Electronic and paper records were reviewed to obtain demographic details and medical history including anthropometry, medications, and blood results. Diabetes medication prescribing was classed as weightneutral/losing and weight-gaining as previously described in Aldekhail et al [30]. The weight-neutral/losing class was composed of patients on metformin only or metformin combined with a SGLT-2 inhibitor, a DPP-4 inhibitor, or a GLP-1 agonist.…”

“…Diabetes medication prescribing was classed as weight-neutral/losing and weight-gaining as previously described in Aldekhail et al [ 30 ]. The weight-neutral/losing class was composed of patients on metformin only or metformin combined with a SGLT-2 inhibitor, a DPP-4 inhibitor, or a GLP-1 agonist.…”

“…Fortunately, the newer agents of sodium-glucose transporter 2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists can promote weight loss, while dipeptidyl peptidase-4 (DPP-4) inhibitors are weight neutral [28,29]. In a recent study, Aldekhail et al showed that class 3 obesity and T2DM patients in a weight loss program prescribed weight-neutral/losing diabetes medications lost more weight than those prescribed weight-gaining medications [30].…”