Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study

Treating class 2-3 obesity with glucagon-like peptide-1 agonists: A 2-year real-world cohort study

AIMS

Despite excellent weight-loss outcomes in clinical trials, Glucagon-Like Peptide 1 receptor agonists (GLP1RA) face challenges with accessibility and compliance in clinical use. We seek to quantify how these barriers impact the long-term weight-loss efficacy of GLP1RAs in the real world.

MATERIALS AND METHODS

In this retrospective cohort study, we analysed weight loss outcomes of patients who were prescribed GLP1RA for class 2-3 obesity treatment between January 2020 and November 2022 in a large non-profit healthcare system in the Midwest. The primary outcome is the two-year total weight loss percentage (TWL%).

RESULTS

During the study period, there was a six-fold growth in GLP1RA prescription numbers. In total, 853 patients were prescribed GLP1RA for obesity treatment. Of these, 211 (24.7%) patients never received the drug and 304 (35.6%) patients had to discontinue treatment within 2 years. The most common reasons for discontinuation included loss to follow-up with the original prescriber (n = 81, 26.6%), side effects (n = 72, 23.7%) and cessation of insurance coverage (n = 65, 21.4%). Two years later, patients who stayed on GLP1RA experienced significantly more weight loss than those who never started it (difference 3.98%, 95% CI 1.57% to 6.41%, p = 0.001) and those who had stopped taking it (difference 5.82%, 95% CI 3.56% to 8.09%, p < 0.001). Patients who stopped GLP1RA within 2 years had similar weight loss to those who never started it (difference 1.83%, 95% CI -1.30% to 4.97%, p = 0.251). The average TWL% for patients who stayed on GLP1RA for 2 years is 9.22% (standard deviation 9.73%).

CONCLUSIONS

Nearly half of the patients who were started on GLP1RA, a treatment intended for indefinite use, stopped taking GLP1RA within 2 years. Patients who stopped treatment experienced similar weight loss to those who never started treatment. For real-world patients who stayed on treatment for 2 years, a lower TWL% was observed than previously reported in clinical trials.

Building Comprehensive Care Networks to Support Lifestyle Change in Patients Taking Obesity Management Medications

There is a sizable proportion of the U.S. population taking obesity management medications (OMMs), accessed through their primary care provider or a specialist. If healthcare providers are prescribing the medications as directed, and patients are taking the medications as directed, they should be doing so in combination with healthy lifestyle behaviors. Specialists in nutrition therapy, physical activity, behavioral counseling, and medical management should work together as a network providing truly comprehensive care. When trained, educated and credentialed in obesity care, this network of providers can coordinate and collaborate to build trust, combat weight stigma and bias, support lifestyle change, and achieve improved health outcomes.

Metabolic dysfunction-associated steatotic liver disease (MASLD) in children with obesity: An Obesity Medicine Association (OMA) and expert joint perspective 2025

Introduction

This Obesity Medicine Association (OMA) Expert Joint Perspective examines steatotic liver disease (SLD), which is composed of metabolic dysfunction-associated steatotic liver disease (MASLD), and metabolic dysfunction-associated steatohepatitis (MASH) in children with obesity. The prevalence of obesity is increasing, rates have tripled since 1963 from 5 % to now 19 % of US children affected in 2018. MASLD, is the most common liver disease seen in children, can be a precursor to the development of Type 2 Diabetes (T2DM) and is the primary reason for liver transplant listing in young adults. We must be vigilant in prevention and treatment of MASLD in childhood to prevent further progression.

Methods

This joint clinical perspective is based upon scientific evidence, peer and clinical expertise. The medical literature was reviewed via PubMed search and appropriate articles were included in this review. This work was formulated from the collaboration of eight hepatologists/gastroenterologists with MASLD expertise and two physicians from the OMA.

Results

The authors who are experts in the field, determined sentinel questions often asked by clinicians regarding MASLD in children with obesity. They created a consensus and clinical guideline for clinicians on the screening, diagnosis, and treatment of MASLD associated with obesity in children.

Conclusions

Obesity and the comorbidity of MASLD is increasing in children, and this is a medical problem that needs to be addressed urgently. It is well known that children with metabolic associated chronic disease often continue to have these chronic diseases as adults, which leads to reduced life expectancy, quality of life, and increasing healthcare needs and financial burden. The authors of this paper recommend healthy weight reduction not only through lifestyle modification but through obesity pharmacotherapy and bariatric surgery. Therefore, this guidance reviews available therapies to achieve healthy weight reduction and reverse MASLD to prevent progressive liver fibrosis, and metabolic disease.

The Effects of Glucagon-Like Peptide-1 Agonist Therapy on Risk of Infection, Fracture, and Early Revision in Primary Total Joint Arthroplasty

INTRODUCTION

The purpose of this study was to examine rates of infection, revision, and periprosthetic fracture following total joint arthroplasty in diabetic patients treated with and without glucagon-like peptide-1 (GLP-1) agonist therapy.

METHODS

The TriNetX Global Collaborative Network was queried for patients with diabetes mellitus undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2005 to 2024. Patients taking GLP-1 agonists within 1 year of surgery were matched to patients without. Cohort matching was done according to race, sex, body mass index nicotine dependence, hemoglobin A1c, and estimated glomerular filtration rate A total of 9,400 TKA procedures and 4,488 THA procedures constituted evenly divided cohorts. Outcomes included infection, revision surgery, and periprosthetic fractures at 3 months and 1 year. Bonferroni correction applied with threshold P < 0.0041.

RESULTS

TKA: periprosthetic infection following TKA was lower in the GLP-1 group compared with the non-GLP-1 group at both 3 months (0.94% vs. 1.45%; P < 0.001) and 1-year (1.21% vs. 2.04%; P < 0.001). Rates of periprosthetic fracture following TKA were higher albeit not markedly in patients prescribed GLP-1 agonists versus patients not receiving GLP-1 agonists at 3-months (0.47% vs. 0.21%; P = 0.034, respectively) and at 1-year (0.70% vs. 0.34%; P = 0.015) postoperatively. THA: No notable differences were observed in rates of infection, revision, or periprosthetic fracture in patients undergoing THA between those prescribed GLP-1s versus patients not receiving GLP-1 agonists at 3-months and 1-year.

CONCLUSION

In this retrospective study of both TKA and THA among diabetic patients, we found that patients using GLP-1 agonists had a lower rate of periprosthetic infection following TKA. The benefits of GLP-1 therapy might limit infection risk, however additional research is needed to understand the effect these medications make on patient nutrition and bone metabolism.

Cardiovascular outcomes of glucagon-like peptide-1 agonist in patients with obesity and hypertrophic cardiomyopathy

BACKGROUND

Obesity is highly prevalent in patients with hypertrophic cardiomyopathy (HCM) and associated with a more severe phenotype and worse outcomes. Glucagon-like peptide-1 (GLP-1) receptor agonists have recently been shown to improve cardiovascular outcomes in patients with obesity. However, their impact on patients with obesity and HCM is unclear. Therefore we sought to assess the safety and efficacy of GLP-1 agonists in patients with obesity and HCM.

METHODS

Using the TriNetX Global Research Network, patients with HCM and BMI ≥30 kg/m2 were identified from 2016 to 2024 and classified into those who received GLP-1 agonists and those who did not. Groups were propensity matched to control for baseline confounders and evaluated for outcomes including all-cause mortality, heart failure hospitalization and arrhythmias.

RESULTS

Of 29,521 patients with HCM, 1553 (5 %) received GLP-1 agonists. After propensity score matching, both groups (n = 1497 in each) had comparable baseline characteristics. Over a 2-year follow-up period, patients with HCM on GLP-1 agonists had a significant reduction in BMI and lower all-cause mortality and HF hospitalization rates compared to patients not on GLP-1 agonists. In contrast, there was no significant differences in new-onset atrial fibrillation or ventricular arrhythmia, nor was there a significant difference in safety events related to GLP-1 agonists use.

CONCLUSION

In this large real-world dataset, the use of GLP-1 agonists in patients with obesity and HCM was associated with improved survival and lower rates of HF hospitalization. These data support future large prospective clinical trials of GLP-1 agonists in patients with obesity and HCM.

Laser Versus Rotational Atherectomy in Coronary Artery Disease: A Systematic Review and Meta-Analysis of Procedural Success and Safety

The evolution of percutaneous coronary intervention (PCI) has improved the management of complex coronary lesions, particularly in heart failure patients. Laser atherectomy (LA) and rotational atherectomy (RA) are used to treat in-stent restenosis and calcified stenosis. Both techniques share similar indications and risks, but direct comparisons of their efficacy and safety are limited. This review examines procedural success, complication rates, and clinical outcomes of RA and LA. PubMed, Embase, and the Cochrane Library were searched to retrieve studies between 2015 and 2025. Primary outcomes included procedural success, major adverse cardiovascular events (MACE), and complications, including dissection and perforation. Random-effects models were used for analysis, with subgroup analyses based on lesion type and complexity. Fourteen studies were included in our meta-analysis (LA: 6 studies; RA: 8 studies). LA showed a procedural success rate of 96.3%, higher than RA (93.3%). The increase in lumen diameter after the procedure was statistically significantly higher in LA (mean difference: 6.71 mm²; 95% CI: (6.64-6.79); p < 0.001) as compared to RA (mean difference: -27.90 mm²; 95% CI: (-27.95,-27.85); p < 0.001). Subgroup analysis revealed that RA worked better on severely calcified lesions that required stentablation. Complication rates were similar between the two techniques (1.2% for LA vs. 1.5% for RA; p = 0.21). LA provides better procedural success and lumen gain in heart failure patients with complex coronary lesions. However, RA remains superior for stentablation in non-dilatable, calcified lesions. Both techniques have similar safety profiles, suggesting the need for individualized treatment based on patient and lesion characteristics.

Association between plausible genetic factors and weight loss from GLP1-RA and bariatric surgery

Obesity is a major public health challenge. Glucagon-like peptide-1 receptor agonists (GLP1-RA) and bariatric surgery (BS) are effective weight loss interventions; however, the genetic factors influencing treatment response remain largely unexplored. Moreover, most previous studies have focused on race and ethnicity rather than genetic ancestry. Here we analyzed 10,960 individuals from 9 multiancestry biobank studies across 6 countries to assess the impact of known genetic factors on weight loss. Between 6 and 12 months, GLP1-RA users had an average weight change of -3.93% or -6.00%, depending on the outcome definition, with modest ancestry-based differences. BS patients experienced -21.17% weight change between 6 and 48 months. We found no significant associations between GLP1-RA-induced weight loss and polygenic scores for body mass index or type 2 diabetes, nor with missense variants in GLP1R. A higher body mass index polygenic score was modestly linked to lower weight loss after BS (+0.7% per s.d., P = 1.24 × 10-4), but the effect attenuated in sensitivity analyses. Our findings suggest known genetic factors have limited impact on GLP1-RA effectiveness with respect to weight change and confirm treatment efficacy across ancestry groups.

GLP-1 Agonists for Weight Loss: Do They Increase Complications in Non-diabetic Patients Undergoing Primary Total Hip Arthroplasty?

BACKGROUND

Glucagon-like peptide 1 (GLP-1) agonists are an effective medication for glycemic control and weight loss. These effects may reduce complications in diabetic patients undergoing total hip arthroplasty (THA). However, there remains a paucity of data on the impact of GLP-1 medications in nondiabetic patients using the medication solely for weight reduction. There is concern that rapid weight loss associated with GLP-1 agonists may lead to malnutrition and increase the risk of postoperative complications in patients undergoing THA.

METHODS

A retrospective query was performed from January 1, 2010, to January 1, 2022, using an insurance claims database to identify patients undergoing primary THA on GLP-1 agonists (n = 839,715). Patients on GLP-1 therapy (n = 5,345) at the time of surgery were propensity score-matched 1:1 to controls who were not on GLP-1 agonists (n = 5,345) based on age, sex, the Elixhauser Comorbidity Index, and its components. Patients who had diabetes mellitus were excluded. The 90-day outcomes were evaluated, including medical complications, readmission, and reoperation rates. We also examined the incidence of all-cause revision and implant-related complications at a 2-year follow-up. Odds ratios (ORs) were generated using logistic regression analyses.

RESULTS

Patients who were on GLP-1 agonist medications were less likely to develop acute blood loss anemia (OR: 0.57; 95% confidence interval [CI]: 0.34 to 0.96) and require postoperative transfusion (OR: 0.53; 95% CI: 0.36 to 0.78) or visit the emergency department within 90 days of surgery (OR: 0.81; 95% CI: 0.69 to 0.92) when compared to patients who did not have GLP-1 therapy. Patients were at comparable risk of deep venous thrombosis, pulmonary embolism, mortality, stroke, myocardial infarction, acute kidney injury, and sepsis regardless of GLP-1 status (P > 0.05). Notably, the rate of aspiration pneumonia was similar between groups (OR: 1.17; 95% CI: 0.62 to 2.19). Also, GLP-1 therapy did not put patients at higher risk of surgical complications, including periprosthetic joint infection, instability, fracture, loosening, or all-cause revision, at 90 days and two years (P > 0.05).

CONCLUSIONS

Use of a GLP-1 agonist does not appear to increase the odds of postoperative medical and surgical complications after THA in nondiabetic patients taking GLP-1 medications for weight loss alone.

Oral versus subcutaneous semaglutide weight loss outcomes after two years among patients with type 2 diabetes in a real-world database

BACKGROUND

Interest has grown in glucagon-like peptide-1 receptor-agonist (GLP-1 RA) semaglutide long-term outcomes. This retrospective cohort study compared effectiveness of oral and subcutaneous semaglutide for weight loss outcomes in adults with type 2 diabetes (T2D) over a 2-year treatment period.

RESEARCH DESIGN AND METHODS

Weight loss was evaluated through mean percentage change from baseline, proportion achieving at least 5% weight loss and at least 10% weight loss comparing subcutaneous (n = 310) versus oral users (n = 57) and by age group.

RESULTS

Subcutaneous users experienced a mean percentage weight loss of 7.5% (16.7 pounds) with 58.7% and 32.9% achieving ≥5% and ≥10% loss, respectively. Oral users lost 4.4% (8.7 pounds) with 50.9% and 17.5% achieving ≥5% and ≥10% loss, respectively. Significant differences existed between formulations in mean percentage weight change (p-value <0.01) and proportion achieving ≥10% loss (p-value = 0.03), but not in proportion achieving ≥5% loss (p-value = 0.34). Outcomes differed by age within oral semaglutide (p-value = 0.02). Regression analyses adjusted for confounders yielded similar findings.

CONCLUSION

Subcutaneous users achieved superior weight loss compared to oral users. Older oral users experienced better weight loss compared to younger users. However, no differences were observed between subcutaneous users.

Glucagon-like peptide-1 receptor agonists and capsule endoscopy in patients with diabetes: a matched cohort study

BACKGROUND AND AIMS

Video capsule endoscopy (VCE) is valuable for assessing conditions like GI bleeding, anemia, and inflammatory bowel disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for diabetes and weight loss, with their pharmacologic effects including delayed gastric emptying. This study investigates the impact of GLP-1RA use on VCE outcomes in patients with diabetes.

METHODS

This retrospective cohort study involves patients with diabetes undergoing VCE while on GLP-1RAs matched in a 1:1 ratio with control subjects, who are not on GLP-1RAs, based on demographics and diabetes-related factors. The primary outcome was gastric transit time in VCE studies, whereas secondary outcomes were incomplete small-bowel evaluation and small-bowel transit time.

RESULTS

In the GLP-1RA cohort with 68 patients, 5 (7%) experienced failure to pass the video capsule through the stomach; all control subjects passed the video capsule successfully (P = .06). GLP-1RA patients had a longer gastric transit time (99.3 ± 134.2 minutes) compared with control subjects (25.3 ± 31.6 minutes, P < .001). Multivariate analysis revealed GLP-1RA use was associated with an increased gastric transit time by 74.5 minutes (95% confidence interval, 33.8-115.2; P < .001) compared with control subjects, after adjusting for relevant factors. Sixteen GLP-1RA patients (23.5%) experienced incomplete passage of the video capsule through the small intestine, a significantly higher rate compared with 3 patients in the control group (4.4%, P < .01).

CONCLUSIONS

GLP-1RA use is associated with a prolonged gastric transit time and a higher rate of incomplete small-bowel evaluation during VCE. Future studies may be crucial for evaluating strategies to mitigate these effects.

Association between plausible genetic factors and weight loss from GLP1-RA and bariatric surgery: a multi-ancestry study in 10 960 individuals from 9 biobanks

Obesity is a significant public health concern. GLP-1 receptor agonists (GLP1-RA), predominantly in use as a type 2 diabetes treatment, are a promising pharmacological approach for weight loss, while bariatric surgery (BS) remains a durable, but invasive, intervention. Despite observed heterogeneity in weight loss effects, the genetic effects on weight loss from GLP1-RA and BS have not been extensively explored in large sample sizes, and most studies have focused on differences in race and ethnicity, rather than genetic ancestry. We studied whether genetic factors, previously shown to affect body weight, impact weight loss due to GLP1-RA therapy or BS in 10,960 individuals from 9 multi-ancestry biobank studies in 6 countries. The average weight change between 6 and 12 months from therapy initiation was -3.93% for GLP1-RA users, with marginal differences across genetic ancestries. For BS patients the weight change between 6 and 48 months from the operation was -21.17%. There were no significant associations between weight loss due to GLP1-RA and polygenic scores for BMI or type 2 diabetes or specific missense variants in the GLP1R, PCSK1 and APOE genes, after multiple-testing correction. A higher polygenic score for BMI was significantly linked to lower weight loss after BS (+0.7% for 1 standard deviation change in the polygenic score, P = 1.24×10-4), but the effect was modest and further reduced in sensitivity analyses. Our findings suggest that existing polygenic scores related to weight and type 2 diabetes and missense variants in the drug target gene do not have a large impact on GLP1-RA effectiveness. Our results also confirm the effectiveness of these treatments across all major continental ancestry groups considered.

Comparative estimate of glucose-lowering therapies on risk of incident pneumonia and severe sepsis: an analysis of real-world cohort data

BACKGROUND

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are treatments for type 2 diabetes (T2D). Beyond glucose-lowering and cardiorenal protection, these drugs may protect against pneumonia and sepsis.

AIMS

This study assesses the impact of SGLT2i and GLP-1 RAs on the risk of incident pneumonia and severe sepsis.

METHODS

A retrospective cohort study was conducted using anonymised electronic medical records from TriNetX, a global federated database. Two intention-to-treat analyses were performed, each with two cohorts of adult T2D patients. The first analysis compared individuals prescribed SGLT2i, and the second individuals prescribed GLP-1 RAs, with those prescribed dipeptidyl peptidase-4 inhibitors (DPP-4i). An active comparator new user design was used, with outcomes defined as time-to-incident pneumonia and severe sepsis. Propensity score matching (1:1) was applied to control for potential confounders, and patients were followed for 12 months. Secondary analyses compared SGLT2i and GLP-1 RAs against other glucose-lowering therapies.

RESULTS

After propensity score matching, 352 687 patients were included in the SGLT2i versus DPP-4i comparison. SGLT2i treatment was associated with a risk reduction in incident pneumonia (HR 0.75 (95% CI 0.73, 0.78)) and severe sepsis (0.75 (0.73, 0.77)). In the GLP-1 RA versus DPP-4i comparison, 331 863 patients were included. GLP-1 RA treatment was associated with a risk reduction in incident pneumonia (0.60 (0.58, 0.62)) and severe sepsis (0.61 (0.59, 0.63)).

CONCLUSION

SGLT2i and GLP-1 RAs are associated with a reduced risk of incident pneumonia and severe sepsis in patients with T2D. Further research and focused randomised controlled trials are warranted to explore the broader clinical implications of these treatments.

Glucagon-like peptide-1 receptor agonist therapy effects on glycemic control and weight in a primary care clinic population

Glucagon-like peptide-1 receptor agonist (GLP-1a) medications have been shown in randomized controlled trials (RCTs) to have consistent and impressive effectiveness in lowering hemoglobin A1c (HbA1c) and weight, but limited data exist on the efficacy of GLP-1a medications in clinical practice. We studied the association between GLP-1a therapy and changes in weight and HbA1c in a real-world patient population. In this retrospective cohort study of patients seen in a primary care clinic between 2012 and 2021, we examined the change in weight and HbA1c over 12 months in a cohort of patients with at least one prescription for a GLP-1a. Within this cohort, treatment was defined as having ≥2 GLP-1a prescriptions at a therapeutic dosage separated by ≥10 months. The cohort included 693 patients of whom 393 (57%) were treated with GLP-1a therapy. The treatment group had a mean change in body mass index (BMI) of -0.83 kg/m2 (±2.88) compared to -0.70 kg/m2 (±2.99) in the without GLP-1a group (p = 0.57). Treated patients had a mean change in HbA1c of -1.00% (±2.07) compared to -0.83% (±1.92) in the without GLP-1a group (p = 0.27). For treated and without GLP-1a patients, respectively, the proportion of patients with a decrease in BMI was 65 versus 64% (p = 0.86), and the proportion with a decrease in HbA1c was 73 versus 69% (p = 0.28). In clinical practice, GLP-1a therapy was associated with more modest reductions in weight and HbA1c than shown in prior RCTs. As GLP-1a use continues to expand throughout primary care, the real-world impact of this pharmacotherapy will require further evaluation.

Weight Trends After Spinal Cord Stimulation Therapy for Chronic Pain

OBJECTIVES

Spinal cord stimulation (SCS) therapy is an effective treatment for chronic pain, particularly in conditions such as postlaminectomy syndrome and complex regional pain syndrome (CRPS). Rare case reports described significant weight loss in patients who underwent dorsal column SCS therapy for chronic pain. Recently, neuromodulation for obesity has become a novel field for research. We aimed to investigate weight trends among patients treated with SCS for chronic pain.

MATERIALS AND METHODS

We conducted a retrospective chart review in 342 patients treated with SCS or dorsal root ganglion stimulators at our institution between 2010 and 2023. Patients had their weight recorded before SCS implantation and at least once within 12 months after surgery. We also conducted interviews with 28 patients who experienced significant weight loss or had revision procedures owing to weight loss.

RESULTS

We found that 105 of 342 patients (30.7%) experienced weight loss of ≥5% within a year of implantation, and 32 of 105 (30.5%, 9.4% of all patients) experienced weight loss of ≥ 10%. A multivariate regression analysis revealed a modest increase in the likelihood of weight loss among patients with CRPS (odds ratio [OR] = 1.17, 95% CI [1.04, 1.30], p = 0.007) and in those who achieved pain relief after implantation (OR = 1.22, 95% CI [1.05,1.40], p = 0.008). Of the 28 patients with significant weight loss who were interviewed, 12 (43%) could not explain the reasons for their weight loss, whereas eight (29%) reported decreased appetite. Leads placed at higher thoracic levels were associated with increased rates of weight loss (37.2% at T6-T8 and 22.3% at T8-T10; p = 0.038).

CONCLUSIONS

Our findings suggest that SCS therapy may affect weight in patients with chronic pain. Further studies are needed to investigate the potential role of SCS in weight modulation.

Methylphenidate can help reduce weight, appetite, and food intake-a narrative review of adults' anthropometric changes and feeding behaviors

Introduction

Obesity constitutes a complex global health that carries several comorbidities that include cardiovascular disease, diabetes, and cancer. Current treatments, such as lifestyle modifications and bariatric surgery, are often difficult to implement or carry risks, creating a need for alternative approaches. Methylphenidate (MPH), a drug commonly used to treat Attention Deficit and Hyperactivity Disorder (ADHD), has shown potential in regulating dopamine levels to modulate appetite and feeding behaviors.

Methods

This narrative review evaluated the effect of MPH in reducing food intake, body weight, and anthropometric indicators in adults with obesity or overweight. Using the PICO method, 39 studies were selected, including 14 randomized controlled trials and 3 observational studies.

Results

MPH canblead to modest weight loss of 1-2% and significant appetite suppression, with stronger effects observed in women, who reported greater reductions in appetite and food cravings. Studies could remain underpowered to detect consistent effects in men.

Discussion

Even if these results suggest MPH could be an option for treating obesity, concerns regarding its safety profile and long-term efficacy persist. This review underscores the need for further investigation to confirm MPH's therapeutic potential, particularly through studies that address gender-specific responses and evaluate its sustainability as a weight management tool.

Sculpting Success: The Importance of Diet and Physical Activity to Support Skeletal Muscle Health during Weight Loss with New Generation Anti-Obesity Medications

Obesity is a public health crisis, with prevalence rates tripling over the past 60 y. Although lifestyle modifications, such as diet and physical activity, remain the first-line treatments, recent anti-obesity medications (AOMs) have been shown to achieve greater reductions in body weight and fat mass. However, AOMs also reduce fat-free mass, including skeletal muscle, which has been demonstrated to account for 20% to 50% of total weight loss. This can equate to ∼6 kg or 10% of total lean mass after 12-18 mo, a loss comparable to a decade of human aging. Despite questions surrounding the clinical relevance of weight loss-induced muscle loss, the importance of adopting lifestyle behaviors such as eating a protein-rich diet and incorporating regular resistance training to support skeletal muscle health, long-term weight loss maintenance, and overall well-being among AOM users should be encouraged. Herein, we provide a rationale for the clinical significance of minimizing weight-loss-induced lean mass loss and emphasize the integration of diet and physical activity into AOM clinical care. Owing to a lack of published findings on diet and physical activity supporting skeletal muscle health with AOMs, specifically, we lean on findings from large-scale clinical weight loss and diet and exercise trials to draw evidence-based recommendations for strategies to protect skeletal muscle. We conclude by identifying gaps in the literature and emphasizing the need for future experimental research to optimize skeletal muscle and whole-body health through a balance of pharmacotherapy and healthy habits.

SGLT2i and GLP1RA effects in patients followed in a hospital diabetology consultation

BACKGROUND

We aimed to investigate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) in patients with type 2 diabetes mellitus (T2DM) in clinical practice.

RESEARCH DESIGN AND METHODS

A total of 340 patients were included. Data on age, gender, antidiabetic medications, and bioanalytical parameters were collected at baseline and one year later. Were analyzed estimated glomerular filtration rate (eGFR), blood sodium and potassium levels, blood pressure, weight, cardiovascular risk, and glycated hemoglobin (HbA1c).

RESULTS

Patients treated with SGLT2i exhibited a significant improvement in eGFR at the endpoint compared to baseline (p = 0.006). Both treatment groups experienced reductions in systolic blood pressure at the endpoint; especially patients treated with SGLT2i (p = 0.0002). GLP1RA treatment resulted in a statistically significant weight reduction from baseline to endpoint (p < 0.0001), with a higher percentage of patients achieving ≥ 5% weight loss compared to the non-GLP1RA group (33.6% vs. 19.8%). Both SGLT2i and GLP1RA treatments significantly reduced cardiovascular risk scores (p = 0.004 and p = 0.002, respectively). Additionally, both treatments were associated with a significant reduction in HbA1c levels at the endpoint (p = 0.010 and p = 0.002, respectively).

CONCLUSIONS

Our findings suggest that SGLT2i and GLP1RA offer beneficial effects in patients with T2DM.

The effectiveness and sustainability of health outcomes from a holistic digital weight-loss service with concomitant initiation of tirzepatide: A pragmatic randomized controlled trial in the UK

AIM

To measure the effectiveness and sustainability of the Juniper UK digital weight-loss service (DWLS), which delivers 6 months of personalized, proactive lifestyle coaching supplemented with tirzepatide to patients through a multidisciplinary team (MDT).

METHODS

An observer-blinded randomized controlled trial (RCT) will be conducted on a cohort of non-diabetic patients of the Juniper DWLS in the UK. Participants in both the intervention and control groups will receive weekly subcutaneous injections of 2.5 mg tirzepatide for 4 weeks, uptitrating the dose to 5.0 mg from weeks 5 to 8, and by 2.5 mg every 4 weeks until reaching 15 mg in week 21, which they will maintain until the end of the intervention period at 6 months, when participants will be taken off the medication. The intervention group will receive personalized weeklylifestyle coaching with a focus on protein intake and resistance training for 6 months. Participants in the control group will attend a diet and exercise group counselling session at programme inception and will be sent a summary of the session's content at months 2 and 4. Aside from these events, health coaches will only interact with control group participants on a reactive basis. From month 6 to month 12, participants from both groups will no longer have access to their MDTs. The trial's co-primary endpoints include weight loss, fat-free to fat-mass ratio and composite strength measures at 12 months (6 months following the end of treatment), compared with baseline. Secondary endpoints include percentage change in weight, fat-free to fat-mass ratio, and composite strength from baseline to 6 months, side effect incidence, and change in cardiometabolic risk factors at 12 months. Quality of life and programme engagement represent the study's exploratory endpoints.

RESULTS

A total of 688 participants enrolled in the study, with a mean age of 44.6 (± 11.4) years and a mean body mass index of 34.8 (± 7.5) kg/m2; 81.0% of participants are women, and 72.8% are of White ethnicity. More than three-quarters of participants have at least one co-morbidity, with dyslipidaemia (42.4%), hypertension (35.3%) and high cholesterol (31.8%) being the most prevalent conditions.

CONCLUSIONS

This RCT will be the first to assess the effectiveness and sustainability of a real-world intensive, multidisciplinary DWLS, and it should highlight the potential of such a service for long-term obesity treatment compared with programmes that deliver standard health counselling.

Oral Semaglutide in Type 2 Diabetes: Clinical-Metabolic Outcomes and Quality of Life in Real-World Practice

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a novel class of incretin mimetics for treating type 2 diabetes (T2D). This study evaluated the impact of semaglutide, the first oral GLP-1RA, on glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and body composition and anthropometric parameters. Additionally, the effects on cardiovascular risk factors and quality of life (QoL) in T2D patients were assessed. Methods: A prospective observational study with a six-month follow-up was conducted. Clinical parameters, including HbA1c, FPG, anthropometric measurements, blood pressure, cardiovascular risk factors, Diabetes Treatment Satisfaction Questionnaire (DTSQ) responses, and Short Form (36) Health Survey (SF-36) responses, were collected at baseline (T0) and at six months (T1). Results: Sixty-one subjects were enrolled, with there being an average T2D duration of 4.67 ± 3.93 years. Significant decreases were observed in HbA1c (µ = -1.24; SD = 1.33; p < 0.05), FPG (µ = -31.01 mg/dL; SD = 41.71; p < 0.05), body composition and anthropometric parameters (p < 0.05), and cardiovascular risk factors (p < 0.05), with an increase in DTSQ scores (p < 0.05). Conclusions: The administration of 14 mg/day oral semaglutide improved several clinical parameters after six months of treatment. These findings suggest semaglutide is effective in improving glycemic control, weight management, and some cardiovascular risk factors in T2D patients.

Clinical Effects of Glucagon-Like Peptide-1 Agonist Use for Weight Loss in Women With Polycystic Ovary Syndrome: A Scoping Review

Glucagon-like peptide-1 (GLP-1) is a gastrointestinal regulatory hormone that stimulates insulin release from the pancreas. While GLP-1 receptor agonists (GLP-1 RAs) have traditionally been utilized to address insulin resistance, their potential application in treating polycystic ovary syndrome (PCOS) has recently garnered attention. This study aimed to investigate the therapeutic efficacy of GLP-1 RAs use for weight loss in women diagnosed with PCOS. We conducted a scoping review following the Joanna Briggs Institute (JBI) methodology and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our investigation delved into the clinical effects experienced by women of diverse racial and ethnic backgrounds with PCOS who were prescribed GLP-1 RAs for weight loss. Peer-reviewed articles from Ovid Medline, Web of Science, CINAHL, Cochrane CENTRAL, SCOPUS, and ClinicalTrials.gov spanning from 2012 to 2023 were scrutinized. After eliminating duplicates, 811 articles were identified, and ultimately, eight met the eligibility criteria for inclusion. All studies were published in English and exhibited wide geographic diversity. The included studies uniformly reported reductions in weight and body mass index (BMI) among patients who were prescribed GLP-1 RAs, specifically liraglutide or exenatide. Additionally, evidence pointed towards improvements in anthropometric parameters (MF1) (including total body weight, BMI, reduction in waist circumference, and total fat percentage), glucose homeostasis, cardiovascular inflammatory markers (midregional pro-atrial natriuretic peptide (MR-proANP) and mid-regional pro-adrenomedullin (MR-proADM)), rates of pregnancy, and menstrual regulation. However, findings regarding the impact of GLP-1 RAs on lipid profiles were inconsistent. Although some short-term adverse effects were noted, long-term effects of GLP-1 RAs use remain undetermined. GLP-1 RA use demonstrated promising clinical outcomes for women with PCOS, including reduced BMI, improved metabolic parameters, menstrual regularity, and increased rates of natural pregnancy. While the current evidence is encouraging, further research is warranted to elucidate both short- and long-term adverse effects of GLP-1 RA therapy for PCOS.

Effectiveness and safety of drugs for obesity

Recent publicity around the use of new antiobesity medications (AOMs) has focused the attention of patients and healthcare providers on the role of pharmacotherapy in the treatment of obesity. Newer drug treatments have shown greater efficacy and safety compared with older drug treatments, yet access to these drug treatments is limited by providers' discomfort in prescribing, bias, and stigma around obesity, as well as by the lack of insurance coverage. Now more than ever, healthcare providers must be able to discuss the risks and benefits of the full range of antiobesity medications available to patients, and to incorporate both guideline based advice and emerging real world clinical evidence into daily clinical practice. The tremendous variability in response to antiobesity medications means that clinicians need to use a flexible approach that takes advantage of specific features of the antiobesity medication selected to provide the best option for individual patients. Future research is needed on how best to use available drug treatments in real world practice settings, the potential role of combination therapies, and the cost effectiveness of antiobesity medications. Several new drug treatments are being evaluated in ongoing clinical trials, suggesting that the future for pharmacotherapy of obesity is bright.

Glucagon-like peptide-1 analogues in monogenic syndromic obesity: Real-world data from a large cohort of Alström syndrome patients

AIM

To examine the real-world efficacy of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in monogenic obesity in patients with Alström syndrome (ALMS).

METHODS

We screened 72 UK adult patients with ALMS and offered treatment to 34 patients meeting one of the following criteria: body mass index of 25 kg/m2 or higher, insulin resistance, suboptimal glycaemic control on antihyperglycaemic medications or non-alcoholic fatty liver disease.

RESULTS

In total, 30 patients, with a mean age of 31 ± 11 years and a male to-female ratio of 2:1, completed 6 months of treatment with GLP-1 RAs either in the form of semaglutide or exenatide. On average, treatment with GLP-1 RAs reduced body weight by 5.4 ± 1.7 (95% confidence interval [CI] 3.6-7) kg and HbA1c by 12 ± 3.3 (95% CI 8.7-15.3) mmol/mol, equating to 6% weight loss (P < .01) and 1.1% absolute reduction in HbA1c (P < .01). Significant improvements were also observed in serum total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and alanine aminotransferase. The improvement of metabolic variables in our cohort of monogenic syndromic obesity was comparable with data for polygenic obesity, irrespective of weight loss.

CONCLUSIONS

Data from our centre highlight the non-inferiority of GLP-1 RAs in monogenic syndromic obesity to the available GLP-1 RA-use data in polygenic obesity, therefore, these agents can be considered as a treatment option in patients with ALMS, as well as other forms of monogenic obesity.

Institutional experience on the impact of glucagon-like peptide-1 agonists (GLP-1) on glycemic control and weight loss in patients with type 2 diabetes at the Dubai Diabetes Center, United Arab Emirates

AIMS

To describe the effect of three classes of GLP1 analogues on HbA1c and weight over one year in a homogenous group of patients at the Dubai Diabetes Center in Dubai, United Arab Emirates. The specific objectives are to study the extent of change in HbA1c and weight loss on these medications as well as the sustainability of change over one year.

METHODS

A retrospective audit of patients diagnosed Type 2 diabetes receiving one of the three following GLP-1 agonists (Exenatide LA 2 mg weekly, liraglutide 1.8 mg once daily, Dulaglutide 1.5 mg) over one year and documenting changes in HbA1c and weight at 3-, 6-, 9-, and 12-months intervals.

RESULTS

The study shows that while there was significant reduction in HbA1c and weight in the first 3 months, this change was not clinically significant. Also, the change was not maintained at the end of the year. By the final quarter, the effect of the medication diminishes, accompanied by a partial regain of weight.

CONCLUSION

GLP1 agonists favorable initial effect on HbA1c and weight may not be sustainable beyond a certain period. The exact reason and factors contributing to this need further exploration.

What can functional brain imaging teach us about remission of type 2 diabetes?

AIMS

With a paradigm shift in attitudes towards type 2 diabetes (T2D), 'weight loss responsive' diabetes is now thought of as a curable disease state. As a result, national programmes are being orchestrated to induce T2D remission soon after diagnosis with aggressive dietary interventions-such as very low-calorie diets (VLCD). However, dietary interventions to achieve weight loss and diabetes remission lack the same long-term sustainability and cardiovascular risk reduction evidence as bariatric surgery. This review aims to explore how brain imaging has contributed to our understanding of human eating behaviours and how neural correlates are affected by T2D.

METHODS

We summarise functional MRI (fMRI) studies looking at human eating behaviour and obesity. We explore how these neural correlates are affected by insulin resistance and T2D itself as well as its different treatment approaches. Finally, we comment on the need for more personalised approaches to maintaining metabolic health and how fMRI studies may inform this.

CONCLUSION

fMRI studies have helped to fashion our understanding of the neurobiology of human appetite and obesity. Improving our understanding of the neural implications of T2D that promote disadvantageous eating behaviours will enable prevention of disease as well as mitigation against a vicious cycle of metabolic dysfunction and associated cognitive complications.