Patients with diabetes often struggle with being overweight or obese, and achieving or maintaining a healthy weight can be a serious and lifelong challenge for these individuals. Lifestyle modifications can improve glycemic control as well as body weight, blood pressure, and lipid profiles. However, behavioral changes are typically challenging and may require the help of others on the diabetes care team. Compounding the problem is that most patients will require multiple medications to manage their diabetes, and an unwanted side effect of some of these therapies is weight gain. This is often a special concern for many people with diabetes who are already overweight or obese. However, while there is the potential for weight gain, these medications are valuable treatments. When used properly, their benefits outweigh their risks.

The Effect of Diabetes Therapies on Weight

Research has shown that insulin, sulfonylureas, and thiazolidinediones may cause weight gain in some patients with diabetes. Weight gain with diabetes medications occurs for a number of reasons. When blood glucose levels are elevated, the excess glucose is excreted through the urine. With treatment, more glucose is available to be used by the body. Any glucose not used by the cells is stored as fat. As a result, patients who continue to consume the same number of calories may gain weight. The use of insulin and sulfonylureas may cause hypoglycemia, which needs to be treated with a fast-acting source of glucose, which can add calories. Thiazolidinediones can cause fat cells to store more fatty acids from the blood, causing those fat cells to enlarge. They can also lead to fluid retention, which may increase body weight.

“There are several therapies for patients with diabetes that have been associated with weight loss or are weight neutral.”

Conversely, there are several therapies for patients with diabetes that have been associated with weight loss or are weight neutral. Metformin and incretin therapies, particularly glucagon-like peptide-1 (GLP-1) receptor agonists, have been associated with weight loss in clinical studies. Dipeptidyl peptidase-4 (DPP-4) inhibitors have been shown to be weight neutral. While metformin, GLP-1 receptor agonists, and DPP-4 inhibitors have been associated with these benefits, it’s important to remind patients that they’re not specifically indicated for weight loss. They’re designed, like other diabetes medications, to lower blood glucose levels.

Educate Patients & Manage Expectations

The side effects of weight gain or weight loss should be taken into consideration and incorporated into the conversation with the patient when considering and prescribing diabetes medications. Although healthcare providers are often limited by time constraints, it’s critical that patients understand the potential for changes in weight and strategies to prevent weight gain in order to help patients have realistic expectations about prescribed therapies. Patients should also be informed that the management of their diabetes is likely to require adjustments to their medication regimens throughout their course of treatment. Be up front about potential side effects, and educate patients on why they’re taking a particular drug and its potential benefits.

Managing expectations is critical to ensuring patients’ trust and helping them to stick with their diabetes care plan, including taking medications. Remind patients that the ultimate goals of the diabetes drugs they take are to help prevent or delay the complications of diabetes so that they have the best possible quality of life. Developing handouts with resources for nutritional and exercise support and other information for patients can help educate them on side effects, including the impact on weight. It’s also important to have a positive attitude with patients about their ability to manage their diabetes and their weight effectively, and offer them encouragement and support.

References

Brown A, Desai M, Taneja D, Tannock LR. Managing highly insulin-resistant diabetes mellitus: weight loss approaches and medical management. Postgrad Med. 2010;122:163-171. Available at:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857968/?tool=pubmed.

Siram AT, Yanagisawa R, Skamagas M. Weight management in type 2 diabetes mellitus. Mt Sinai J Med. 2010;77:533-548. Available at: http://bit.ly/pyLbqe.

Schwartz SS, Kohl BA. Glycemic control and weight reduction without causing hypoglycemia: the case for continued safe aggressive care of patients with type 2 diabetes mellitus and avoidance of therapeutic inertia. Mayo Clin Proc. 2010;85(Suppl):S15-S26.

Schwartz SS, Kohl BA. Glycemic control and weight reduction without causing hypoglycemia: the case for continued safe aggressive care of patients with type 2 diabetes mellitus and avoidance of therapeutic inertia. Mayo Clin Proc. 2010;85(Suppl):S15-S26.

 Mavian AA, Miller S, Henry RR. Managing type 2 diabetes: balancing HbA1c and body weight.Postgrad Med. 2010;122:106-117.