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Comparative Weight Change With Initiation and Adherence to Common Medications for Type 2 Diabetes.
Nadia M Sneed1, Sheryl L Rifas-Shiman2, Joshua Petimar2,3
1School of Nursing, Vanderbilt University, Nashville, Tennessee, USA.
Obesity (Silver Spring, Md.)
|October 16, 2025
Summary
Initiating glucagon-like peptide-1 receptor agonists (GLP-1RAs) or sodium-glucose cotransporter 2 (SGLT-2) inhibitors can lead to significant weight loss in adults with type 2 diabetes. These medications show promise for managing weight alongside glucose control.
Area of Science:
- Endocrinology and Metabolism
- Pharmacotherapy for Type 2 Diabetes
- Obesity Management in Diabetes
Background:
- Type 2 diabetes management often requires additional glucose-lowering medications beyond metformin.
- Weight change is a critical factor influencing metabolic health and treatment decisions in type 2 diabetes.
- Understanding the population-level impact of different medication classes on weight is essential for clinical practice.
Purpose of the Study:
- To estimate the population-level effects on weight change associated with initiating or adhering to specific glucose-lowering medications in adults with type 2 diabetes already on metformin.
- To compare the average 24-month weight change across various medication classes including DPP4 inhibitors, GLP-1RAs, SGLT-2 inhibitors, long-acting insulin, and sulfonylureas.
Main Methods:
- A target trial emulation was conducted using electronic health record data from 22,601 adult patients prescribed metformin.
- Inverse probability weighting of marginal structural models with standardization by baseline covariates was employed.
- The study assessed the initiation and adherence to DPP4 inhibitors, GLP-1RAs, SGLT-2 inhibitors, long-acting insulin, and sulfonylureas.
Main Results:
- Initiation/adherence to glucagon-like peptide-1 receptor agonists (GLP-1RAs) was associated with an average weight loss of 5.15 kg at 24 months.
- Sodium-glucose cotransporter 2 (SGLT-2) inhibitors demonstrated the most significant weight loss, averaging 6.71 kg at 24 months.
- Dipeptidyl peptidase IV (DPP4) inhibitors showed modest weight loss at 6 months but not sustained at 12 or 24 months; glimepiride was associated with weight gain initially.
Conclusions:
- GLP-1RAs and SGLT-2 inhibitors are effective in promoting significant average weight loss over 24 months in adults with type 2 diabetes on metformin.
- These findings highlight the potential of GLP-1RAs and SGLT-2 inhibitors as valuable therapeutic options for managing both glycemic control and weight in type 2 diabetes.
Keywords:
glucagon‐like peptide‐1 receptor agonistsobesitysodium‐glucose cotransporter 2target trialtype 2 diabetesMore Related Videos
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