The Impact of Type 2 Diabetes Medications on Weight

Dr. Osama Hamdy is the author of The Diabetes Breakthrough and the Director of the Why WAIT program at Joslin.

This post is written by Osama Hamdy, M.D.,Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management at Joslin Diabetes Center, Assistant Professor of Medicine at Harvard Medical School.

In my last blog post, I discussed how targeting weight loss can be an effective step in managing diabetes. And, I mentioned, it is often a good idea to consider whether your diabetes medications can actually cause you to gain weight.

Medications that cause weight-gain:

  • Medications like glyburide and glipizide are effective in lowering blood glucose but they generally cause weight gain. If you must take them, using the extended-release versions (glipizide XL or glimepiride) is preferable.
  • Although Actos (pioglitzone) and Avandia (rosiglitazone) increase insulin action, they generally cause significant weight gain.
  • Insulin is the strongest diabetes medication.  Its use, in general also causes significant weight gain. In the Why WAIT program, we used certain types of insulin and novel techniques to minimize the impact of insulin on body weight. This method is described in details in “The Diabetes Breakthrough.”

Medications with no effect on body weight or that aid in weight-loss:  

  • Metformin doesn’t raise or lower your body weight, but can help keep your morning blood glucose levels in check.
  • DPP-4 inhibitors are newer diabetes medications that also don’t affect weight. Examples are DPP-4 inhibitors (Januvia, Galvus, Onglyza, Tradjenta, and Nisena). These medications are expensive.
  • SLGT-2 inhibitors are the newest oral diabetes medication and are known to cause weight loss.  Examples of SGLT2 inhibitors are Invokana and Farxiga, with many more being created. These medications are also expensive.
  • Byetta, Victoza, Bydureon, and Symlin are the only injectable diabetes medications that can help you to lose weight and can be combined with metformin for maximum effect in people with type 2 diabetes. Symlin can be also used for type 1 patients who are overweight or obese. All these injectable diabetes medications are very expensive and may not be covered by insurance.

Reducing the number and doses of the first group of medications can help you lose weight and better control your diabetes. If you’re taking any of these medications, I recommend speaking to your doctor or healthcare team about medications that will not cause weight-gain.

Making sure you have the right medications and following The Why WAIT approach will help you control your diabetes while also teaching you to both lose weight and keep it off.

 

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