The impact of weight gain on motivation, compliance, and metabolic control in patients with type 2 diabetes mellitus

Abstract

Patients with type 2 diabetes, approximately 85% of whom are overweight or obese, often have an increased incidence of cardiovascular disease (CVD) risk factors such as hypertension and dyslipidemia. Both type 2 diabetes and obesity are independent risk factors for CVD. Unfortunately, many therapies aimed at maintaining and improving glucose control are associated with weight gain. Among the older antidiabetes agents, most, including the insulin secretagogues and sensitizers, can lead to weight gain, except for metformin, which is weight-neutral. Among the newer agents, the dipeptidyl peptidase-4 inhibitors generally are weight-neutral in addition to lowering glucose, while the glucagon-like peptide-1 receptor agonists lead to weight reduction. Patients with type 2 diabetes are at an increased risk for both diabetes- and CV-related outcomes, and weight reduction is an important component of diabetes management. Weight gain in patients with type 2 diabetes can contribute to patient frustration and may negatively impact their compliance to therapeutic regimens. The selection of antidiabetes agents that not only improve glucose control but reduce or have a neutral effect on weight with beneficial effects on lipids are ideal options for managing patients with type 2 diabetes.

Conflict of interest statement

Conflict of Interest Statement

F. Xavier Pi-Sunyer, MD discloses conflicts of interest with Amylin Pharmaceuticals, AstraZeneca, Eli Lilly and Co., Novo-Nordisk, and Roche.

Figures

Figure 1

Effects of weight loss (with very low-energy diets) on fasting plasma glucose in patients with obesity and type 2 diabetes mellitus. Values (with SEM bars) are expressed as percentages of baseline values. Baseline fasting plasma glucose values were 14 mmol/L (95% confidence interval, 12–15.9 mmol/L). Mean values from 10 studies including 152 subjects. Reprinted with permission from J Am Coll Nutrition. Abbreviation: SEM, standard error of the mean.

Figure 2

Progressive reductions in weight from baseline (P < 0.0001) in patients with type 2 diabetes treated with exenatide 10 µg twice daily. Abbreviation: CI, confidence interval. Reprinted with permission from Curr Med Res Opin.