The news that diabetes medications help you lose weight has recently gone viral. But does it really work? Should you use it if you don’t have diabetes? Let’s find out.
Content reviewed by Dr. Adarsh Gupta
– Founding medical director, Valley Forge Weight Management Center
– His Publications
Approximately 37.1 million people live with diabetes in the United States. Of them, about 28.7 million people have been diagnosed with diabetes (including 28.5 million adults), and about 8.5 million people are undiagnosed (23.0% of adults). With the rising rates of obesity, the prevalence of diabetes is also expected to rise further. It is well known that obesity is one of the strongest risk factors for type 2 diabetes.
With substantial weight loss, remission of diabetes has also been demonstrated to occur in a large number of cases. Until now, however, treatment for obesity and diabetes had to be done independently. Undoubtedly, one of the problems with older anti-diabetic medicines like insulin, sulfonylureas, and pioglitazone is the weight gain that accompanies them. Hence, while the sugar levels usually get under control, one of the unwanted side effects of these medicines was weight gain.
Let’s understand the effects of diabetes medicines on weight loss!
Do diabetes medicines lower the risk of obesity?
It depends on the class of diabetes drug. Here is the breakdown of diabetes drug types and their effect on weight.
Diabetes drugs that cause weight gain
- Thiazolidinedione (or TZDs)
Diabetes drugs that are weight neutral (neither causes weight gain nor weight loss)
- DPP-4i dipeptidyl peptidase 4 inhibitor
- Alpha-glucosidase inhibitor
Diabetes drugs that cause weight loss
- GLP-1 RA glucagon-like peptide-1 receptor agonist
- SGLT-2i sodium-glucose co-transporter 2 inhibitor
- Metformin (some weight loss)
More recently, however, two groups of agents, the SGLT-2i drugs and the GLP-1 RA, developed to control diabetes have been found effective in helping patients lose weight. There are many SGLT-2i drugs and GLP-1 RA drugs. But the drug that has received a lot of media attention is Semaglutide, which is indicated for the treatment of diabetes under the brand name – Ozempic & Rybelsus. It is also indicated for the treatment of obesity under the brand name – Wegovy.
Do diabetes drugs work for weight loss?
While the weight loss with SGLT-2i groups is modest, the GLP-1 RA drugs are quite remarkable for weight loss. GLP-1 RA under the brand name Ozempic (once weekly injection) and Rybelsus (once-daily oral medication) are available at the dose that treats diabetes and causes some weight loss as well. The GLP-1RA under the brand name Wegovy (once weekly injection) is titrated to a higher dose to cause remarkable weight loss. This drug is approved for chronic weight management by FDA.
Most of the GLP-1 RA are injectables, except Rybelsus, which is the only one in oral form. Oral semaglutide is indeed the first ‘peptide in a pill’.
The GLP-1 RAs have additional benefits. Apart from weight loss and blood sugar control, they are also cardio-protective and have been shown to protect against atherosclerotic cardiovascular disease.
The benefits of diabetes drugs go beyond the basics
The SGLT-2i drugs also have multiple other benefits apart from blood sugar control and weight reduction. Most importantly, they prevent heart failure. Cardiologists now use this drug as the first line in the treatment of heart failure, even in those without diabetes. SGLT-2i drugs also have a kidney protection effect. Hence, nephrologists have started using these drugs to protect the kidney, even those without diabetes.
The SGLT-2i drugs and the GLP-1 RA can be used along with other oral antidiabetic drugs and insulin. Thus, the treatment of diabetes has come a long way with the introduction of these newer agents.
Since the GLP-1 RA drugs are available in multiple brand names with different indications, it is important to know that the brand indicated for weight loss has used these drugs at higher doses and was provided to patients as an adjunct to a healthy lifestyle in the clinical trials. One should not use these drugs without a healthy lifestyle program and without a doctor’s supervision.