The main goal in the treatment for type 2 diabetes is prevention or delay of complications, and improvement of quality of life. This is achieved by the reduction of hyperglycemia (high blood glucose), reduction of hypoglycemia (low glucose) events, and avoiding weight gain.
Over 10% of people in the U.S. have diabetes and most people with type 2 diabetes are overweight or obese at the time of diagnosis. Weight loss has been shown to improve glycemic control in people with type 2 diabetes, as well as reduce the risk of coronary heart disease.
The variety of diabetes medicines in the market today is wide and some can affect a person’s body weight – either by weight gain, weight loss, or no effect on weight.
Here are the medication groups for treating diabetes and their effect on weight:
Diabetes medications that affect weight gain:
- Insulin – Helps glucose move from the blood to cells in your body and thus lowers the glucose level. If the glucose level is still in excess the insulin will accumulate it as fat. This extra fat can lead to weight gain over time. Most forms of insulin cause weight gain.
- Sulfonylureas – Specific medicines that stimulate the pancreas to produce more insulin: Glimepiride (Amaryl), Glipizide (Glucotrol), Glyburide.
- Meglitinides – Similar to sulfonylureas, they cause the pancreas to release more insulin as: Nateglinide (Starlix), Repaglinide.
- Thiazolidinediones – Increases insulin sensitivity and thus lower blood glucose levels, but they also affect genes involved in fat formation and thus may cause weight gain. Medication in this group include Pioglitazone (Actos), Rosiglitazone (Avandia).
Diabetes medications that affect weight loss:
- GLP-1 agonists – A group of medicines based on GLP1: a hormone in our body that tells our pancreas to release insulin after we eat. It also helps us feel full between meals: Dulaglutide (Trulicity), Exenatide (Byetta, Bydureon BCise), Liraglutide (Victoza), Semaglutide (Ozempic, Rybelsus), Lixisenatide (Lyxumia).
- SGLT-2 inhibitors – Cause excess glucose from the blood to be excreted in the urine. Less blood glucose means less glucose is available to convert to fat . Medication in this group includes: Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance).
- Metformin – Lowers the amount of glucose produced in the liver and makes the body more sensitive to the natural insulin produced in the pancreas. Some people treated with this drug will lose weight.
- Pramlintide (Smylie), Pramlintide (Sympli) – Functions as an amylin hormone in the body which slows down the movement of food through the stomach and prevents liver from producing excess glucose.
Diabetes medications that have little or no effect weight – “weight-neutral”:
- Dipeptidyl peptidase-4 (DPP-4) inhibitors – Affect the lowering of blood glucose levels by helping to raise the natural levels of GLP-1 in the body. Unlike the use of GLP1 itself which lowers weight, this group has insignificant effect on weight. This group includes: Alogliptin (Nesina), Linagliptin (Tradjenta), Saxagliptin (Onglyza), Sitagliptin (Januvia)
In summary, there are many ways to treat diabetes, including a combination of lifestyle changes and medications. Different drugs have different side effects and one of them is the effect on body weight.
Note that weight changes due to diabetes medications may be preventable. Everyone responds differently, it is important that you stay connected with your health care provider and report how the medication is affecting you.
https://pubmed.ncbi.nlm.nih.gov/ 18035865/
https://www.goodrx.com/conditions/ diabetes/diabetes-medications-that-can-cause-weight-gain
DAR-0273 RevA