From the Guidelines
GLP-1 receptor agonists, such as semaglutide and tirzepatide, are the most effective medications for weight loss in people with diabetes, producing a significant reduction in body weight and improving glycemic control, as recommended by the latest guidelines 1. When considering weight loss with GLP-1 in the setting of diabetes, it is essential to prioritize medications with a beneficial effect on weight, such as GLP-1 receptor agonists, which have been shown to produce a mean weight loss of 5-15% over 6-12 months 1. Some key points to consider when using GLP-1 receptor agonists for weight loss in people with diabetes include:
- Semaglutide is particularly effective, with weekly injections starting at 0.25mg and gradually increasing to 1-2mg for diabetes or up to 2.4mg for weight management 1
- Tirzepatide, a combined glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist, has also been shown to produce significant weight loss, with a mean weight change of up to −20.9% compared with placebo in obese adults without diabetes over 72 weeks 1
- GLP-1 receptor agonists work by slowing gastric emptying, increasing satiety, and reducing appetite through central nervous system effects, and also improve glycemic control by stimulating insulin secretion and suppressing glucagon 1
- Side effects typically include nausea, vomiting, and diarrhea, which often improve with time, and regular monitoring is important, with dose adjustments needed based on response and tolerability 1
- These medications are generally well-tolerated but contraindicated in patients with personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2 1 It is also important to note that weight management pharmacotherapy should be considered for people with diabetes and overweight or obesity, along with lifestyle changes, and that the preferred pharmacotherapy should be a GLP-1 receptor agonist or dual GIP and GLP-1 receptor agonist, such as semaglutide or tirzepatide, especially considering their added weight-independent benefits, such as glycemic and cardiometabolic benefits 1.
From the Research
Weight Loss with GLP-1 in Diabetes
- Weight loss is a key aspect of managing diabetes, and GLP-1 receptor agonists have been shown to be effective in achieving this goal 2, 3, 4.
- GLP-1 receptor agonists work by augmenting hyperglycemia-induced insulin secretion, suppressing glucagon secretion, decelerating gastric emptying, and reducing calorie intake and body weight 2.
- Studies have demonstrated that GLP-1 receptor agonists can lead to significant weight loss, with some agents showing greater efficacy than others 2, 3, 4.
- The use of GLP-1 receptor agonists for weight loss is not limited to patients with diabetes, as they have also been approved for weight management in non-diabetic individuals 3.
Mechanisms of Action
- GLP-1 receptor agonists have several mechanisms of action that contribute to their weight-loss effects, including:
- Augmentation of hyperglycemia-induced insulin secretion
- Suppression of glucagon secretion
- Deceleration of gastric emptying
- Reduction in calorie intake and body weight 2
- These mechanisms work together to promote weight loss and improve glycemic control in patients with diabetes.
Clinical Evidence
- numerous studies have demonstrated the efficacy of GLP-1 receptor agonists for weight loss in patients with diabetes 2, 3, 4.
- A review of the literature found that GLP-1 receptor agonists can provide significant weight loss, as well as improvements in glycemic control and cardiovascular risk factors 4.
- Another study found that GLP-1 receptor agonists can be used in combination with lifestyle modifications to achieve greater weight loss and improvements in glycemic control 5.
Comparison to Other Weight-Loss Strategies
- Lifestyle modifications, such as diet and exercise, are also effective for weight loss and can be used in combination with GLP-1 receptor agonists 5, 6.
- A review of the literature found that the most effective weight-loss intervention is one that includes a moderately reduced-calorie diet, increased physical activity, and the use of behavior strategies to facilitate adherence 6.