From the Guidelines
Some diabetic patients are overweight or gain weight easily due to several interconnected mechanisms, including insulin resistance, certain diabetes medications, and disrupted energy regulation, which can be managed with lifestyle changes and medications like metformin, GLP-1 receptor agonists, and SGLT-2 inhibitors. Insulin resistance is a primary factor, where cells don't respond properly to insulin, causing the pancreas to produce more insulin 1. This excess insulin promotes fat storage and inhibits fat breakdown. Many diabetes medications, particularly insulin, sulfonylureas (like glipizide and glyburide), and thiazolidinediones (like pioglitazone), can cause weight gain as a side effect 1. Insulin therapy often leads to weight gain because it helps glucose enter cells more efficiently, increasing calorie storage. Additionally, diabetic patients may experience increased hunger (polyphagia) as a symptom, leading to higher caloric intake. Defensive eating to prevent hypoglycemia is common, where patients eat extra food to avoid low blood sugar episodes, especially when taking insulin or sulfonylureas. Some patients also have a reduced metabolic rate, making weight management more challenging. The body's energy regulation becomes disrupted in diabetes, affecting hunger hormones like leptin and ghrelin.
According to the 2020 European Heart Journal study, lifestyle changes, including reduced calorie intake and moderate-to-vigorous physical activity, are key to preventing diabetes and its cardiovascular complications 1. The study also found that even modest weight loss can delay the progression from pre-diabetes to type 2 diabetes. For better weight management, medications like metformin, GLP-1 receptor agonists (such as semaglutide or liraglutide), and SGLT-2 inhibitors (like empagliflozin) may be preferred as they typically don't cause weight gain and some may even promote weight loss 1.
Key factors contributing to weight gain in diabetic patients include:
- Insulin resistance and excess insulin production
- Certain diabetes medications, such as insulin, sulfonylureas, and thiazolidinediones
- Disrupted energy regulation and hunger hormones
- Reduced metabolic rate
- Defensive eating to prevent hypoglycemia
The most effective approach to managing weight in diabetic patients is a combination of lifestyle changes, including reduced calorie intake and increased physical activity, and medications that promote weight loss or are weight-neutral. This approach can help improve glycemic control, reduce cardiovascular risk factors, and enhance overall quality of life 1.
From the FDA Drug Label
Mean baseline body weight was 201 lbs and 206 lbs in the metformin hydrochloride tablets and placebo arms, respectively. Mean change in body weight from baseline to week 29 was -1.4 lbs and -2. 4 lbs in the metformin hydrochloride tablets and placebo arms, respectively. Mean baseline body weight was 202 lbs, 203 lbs, and 204 lbs in the metformin hydrochloride tablets /glyburide, glyburide, and metformin hydrochloride tablets arms, respectively. Mean change in body weight from baseline to week 29 was 0.9 lbs, -0.7 lbs, and -8. 4 lbs in the metformin hydrochloride tablets /glyburide, glyburide, and metformin hydrochloride tablets arms, respectively.
The mechanism of why some diabetic patients are overweight or gain weight easily is not directly explained in the provided drug label. However, the label does provide information on the mean baseline body weight and mean change in body weight of patients with type 2 diabetes mellitus in different treatment arms.
- Key points:
- The mean baseline body weight of patients in the studies ranged from 201 to 206 lbs.
- The mean change in body weight from baseline to week 29 varied across treatment arms, with some arms experiencing weight loss and others experiencing weight gain.
- Clinical decision: The exact mechanism of weight gain in diabetic patients is not explicitly stated in the label, and therefore, no conclusion can be drawn from this data alone 2.
From the Research
Mechanism of Weight Gain in Diabetic Patients
- Diabetic patients often experience weight gain or are overweight due to various factors, including insulin resistance and medication side effects 3.
- Insulin resistance, a common condition in type 2 diabetes, can lead to weight gain as the body produces more insulin to compensate for the resistance, resulting in increased glucose storage and fat accumulation 4.
- Certain medications, such as sulfonylureas, can also contribute to weight gain by stimulating insulin secretion and increasing glucose uptake in the body 4.
Role of Medications in Weight Management
- Metformin, a commonly used medication for type 2 diabetes, can help with weight loss or stabilization by improving insulin sensitivity and reducing glucose production in the liver 4, 5.
- Other medications, such as SGLT2 inhibitors and GLP-1 analogues, have been shown to promote weight loss and improve glycemic control in diabetic patients 6.
- Weight loss medications and metabolic surgery can also be effective in achieving weight loss and improving glycemic control in diabetic patients 7.
Importance of Nutrition Therapy and Lifestyle Changes
- Nutrition therapy and lifestyle changes, such as a reduced energy intake and increased physical activity, are essential for achieving and maintaining weight loss and improving glycemic control in diabetic patients 7.
- Modest weight loss can improve glycemia, lipids, and blood pressure in diabetic patients, and can also reduce the risk of diabetes-related complications 7.
- A comprehensive approach to weight management, including medication, nutrition therapy, and lifestyle changes, can help diabetic patients achieve and maintain a healthy weight and improve their overall health outcomes 3, 7.