14-PUB: The Effect of Structured Intensive Lifestyle Intervention on Muscle Mass in Patients with Type 2 Diabetes Receiving GLP-1 Receptor Agonists

Glucagon-like-peptide-1 receptor agonists (GLP-1RAs) emerged as an important treatment option for type 2 diabetes (T2D) for their dual efficacy in improving glycemia and reducing body weight. However, they significantly reduce fat free mass (FFM), a surrogate for muscle mass, putting patients at a higher risk for sarcopenia and its sequelae. It is unknown whether structured intensive lifestyle intervention (sILI), that includes higher protein intake and strength exercises, can mitigate muscle mass loss with GLP-1RA use. We retrospectively evaluated 53 patients with T2D enrolled in a 12-week multidisciplinary sILI (mean age 58.17±11.3 years; 51% male; weight 104.3±19.7 kg; BMI 36.1±5.6 kg/m², A1C 7.4±1.3%) and divided them into two groups: group 1, already taking GLP-1RA (n=32), and group 2, not on GLP-1RA (n=21). Both groups were instructed to follow a hypocaloric structured medical nutrition therapy plan with increased protein intake to 1-1.5 gm/kg of adjusted body weight. They were also instructed to exercise for 360 minutes/week with more emphasis on strength exercises. Body composition was analyzed by bioelectrical impedance. At 12 weeks, group 1 lost 7.4±4.5 kg (p<0.001) and group 2 lost 6.2±5.4 kg (p<0.001), and their A1C decreased by 0.84%±1.1% (p<0.001) and by 1%±1.06% (p<0.001) respectively, with no differences between groups over time. Group 1 had no change in FFM compared to baseline while group 2 lost 1.4±2.6 kg (p<0.05). There was no difference in FFM loss between groups over time (p=0.28). Our findings suggest that increasing protein intake and strength exercises, as part of sILI, may mitigate the deleterious effect of GLP-1RA on muscle mass in patients with T2D. These results support recommending an increase in protein intake and incorporation of strength exercises when GLP-1RA is prescribed for patients with T2D to minimize muscle mass loss. Further research is needed to validate these findings in a randomized prospective study.