Metabolic Outcomes in Patients With Type 2 Diabetes Prescribed Incretin-Based Therapy and Referred or Not to a Weight...

Incretin therapies yield strong metabolic improvements, but whether adding a weight-management (WM) clinic confers additional benefit beyond pharmacotherapy alone in routine care is unclear.

Evaluate whether referral to WM clinic, alongside standard diabetes care, provides additional benefit for adults with type 2 diabetes (T2DM) and obesity treated with incretin therapies regarding changes in A1c, body weight, and LDL.

Retrospective cohort study within an academic health system (2018-2023); adults with T2DM and obesity initiating an incretin were grouped by care model (diabetes care alone, DM, vs. diabetes care plus WM clinic, DM + WM). N = 1445 (DM n = 1,163, DM + WM n = 282). The DM + WM group was stratified based on the number of visits. Primary outcomes were change from baseline to last follow-up in A1c (%), body weight (kg), and LDL (mg/dL). Weighted linear models reported within-group changes and between-group adjusted mean differences with 95% CIs, controlling for baseline values and prespecified covariates (sex, race/ethnicity, age, comorbidity, medication categories, care period).

Among 1445 patients (DM n = 1163; DM + WM n = 282), both groups improved from baseline: weight -4.95 versus -6.00 kg, A1c -0.38% versus -0.37%, LDL -12.19 versus -11.60 mg/dL (all within-group p < 0.05). In adjusted models, the DM + WM (1 visit) group lost less weight than the DM group by +4.1 kg (95% CI 1.2-7.1 kg; p = 0.006) while the DM + WM (4 + visit) group lost more weight with of -4.4 kg (95% CI -6.7 to -2.0 kg, p = 0.0003). Other differences were not statistically significant: A1c + 0.01% (-0.27 to 0.28; p = 0.96), LDL + 0.58 mg/dL (-6.01 to 7.16; p = 0.86).

Among adults starting incretin therapy in routine practice, significant improvements in A1c, weight, and LDL were observed. Patients attending one weight management visit lost less weight than those attending only the DM clinic, while those attending 4 + WM visits lost significantly more weight. Potential long-term effects of WM-based support were not assessed.