Weight loss in individuals with obesity (O) and type 2 diabetes (T2D) may improve glycemic control, prevent obesity-related comorbidities and, in some cases, induce remission of T2D. Glucose-lowering drugs such as SGLT2i and GLP-1 RAs are able to control simultaneously body weight and glucose levels; their use is recommended in individuals with O and T2D. Recently, we have demonstrated the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) in promoting weight loss up to 1 year in individuals with O, with and without T2D. The aim of this retrospective comparative study was to compare the efficacy of SGLT2i, GLP1-RA and rTMS in reducing body weight in the long term in patients with O and T2D. Data obtained from 31 patients with O and T2D were retrospectively analyzed: 11 were treated for O with high frequency rTMS for 5 weeks, 8 subjects were treated for T2D with SGLT2i for 1 year, and 12 individuals were treated for T2D with GLP1-RA for 1 year. Changes in body weight and HbA1c in the 3 groups were analyzed with ANOVA, after 6 months (FU1) and 1 year (FU2) from the beginning of the treatment. The change in body weight between the 3 groups was significant at both FU1 [−3.2±1.8% (SGLT2i) vs −3.5%±1.5% (GLP1-RA) vs −6.3±4.0% (rTMS);p=0.026] and FU2 [−2.1±2.1% (SGLT2i) vs −2.1±4.2% (GLP1-RA) vs −6.7±4.7% (rTMS); p=0.017]. Glycated hemoglobin variation was higher in the SGLT2i and GLP-1 RA groups than in rTMS at FU1 [−11.7±25.1% (SGLT2i) vs −11.9%±13.2% (GLP1-RA) vs −8.9±10.4% (rTMS)] and at FU2 [−15.9±24.2% (SGLT2i) vs −7.8±11.9% (GLP1-RA) vs −5.6±9.0% (rTMS)], although not statistically significant. TMS was found to be more effective than SGLT2i and GLP1-RAs in promoting long-term weight loss in a population with O and T2D, likely due to a prevalent effect of rTMS on appetite control at the meso-cortico-limbic system’s level. These findings set the stage for a potential combined use of rTMS with SGLT2i or GLP1-RAs in treatment of O and T2D.


A.Ferrulli: None. S.Massarini: None. C.Macrì: None. P.Senesi: None. I.Terruzzi: None. D.Cannavaro: None. L.Luzi: Advisory Panel; Eli Lilly and Company, Medtronic, Research Support; Gelesis, Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc., Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Novo Nordisk, Novartis.


IRCCS MultiMedica (Ricerca Corrente)

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