Background: Obesity and type 2 diabetes mellitus (T2DM) are inextricably linked. Obesity is the pathophysiologic driver of T2DM, and as such, the treatment of obesity can improve glycemic control. Although there is some data from phase 3 trials of anti-obesity pharmacotherapy in patients with T2DM, there is currently a paucity of data related to the weight-centric management of T2DM in clinical practice. Data from clinical trials of these medications suggests that weight loss outcomes in patients with T2DM are inferior, likely due to the weight gain promoting effects of concomitant antidiabetic therapies.
Methods: In a retrospective study, electronic medical records of 359 consecutive new patients seen at the Weill Cornell Comprehensive Weight Control Center from 4/1/14-4/1/15 were reviewed and data related to demographics, medications, weight, and HbA1c was recorded.
Results: 48 of 359 patients had T2DM. Baseline age and BMI were 56.2±10.6 years and 39.5±7.6 kg/m2 in patients with T2DM and 48±14.7 years and 35.6±6.8 kg/m2 in patients without T2DM; 54.2% and 70.7% were female, respectively. Management strategies in patients with T2DM included the addition and dose escalation of metformin, GLP-1 agonists, and SGLT2 inhibitors, discontinuation of sulfonylureas and TZDs, and dose reduction of insulin when possible. 56.3% of patients with T2DM were started on anti-obesity pharmacotherapy including lorcaserin, phentermine, topiramate and bupropion. At 12 months, weight loss was 8.9±7.8% in patients with T2DM and 8.6±7.7% in those without T2DM. In patients with T2DM, HbA1c was 7.1±1.1% at initial visit and 6.7±1.3% at 12 months.
Conclusions: In this review, weight loss outcomes were similar in patients with and without T2DM. We show that by using a weight-centric approach to diabetes management, patients can achieve glycemic control with concomitant weight loss.
L. Mandel: None. A. Shukla: None. R. Kumar: Speaker's Bureau; Self; Novo Nordisk Inc., Janssen Pharmaceuticals, Inc.. J. Waitman: None. L. Aronne: Board Member; Self; Myos Corporation, Jamieson Wellness. Consultant; Self; Aspire Bariatrics, Eisai Inc., Novo Nordisk Inc.. Research Support; Self; Pfizer Inc.. Consultant; Self; Takeda Pharmaceuticals U.S.A., Inc.. Research Support; Self; Zafgen. Other Relationship; Self; BMIQ, Gelesis, ERX Pharmaceuticals, Inc.. Research Support; Self; AstraZeneca. Consultant; Self; Sanofi, Janssen Pharmaceuticals, Inc., UnitedHealth Group.
