GLP-1 Analogs Are Superior in Mediating Weight Loss But Not Glycemic Control in Diabetic Patients on Antidepressant Medications: A Retrospective Cohort Study.

Abstract

Objective: Both antipsychotic and antidepressant medications have been associated with weight gain and hyperglycemia. Our previously published retrospective cohort study suggests that GLP-1 (glucagon-like peptide-1) analogs may be superior to alternative regimens for both glycemic and weight control in patients on antipsychotic plus/minus antidepressant medications. In the current study, we asked whether GLP-1 analogs or SGLT-2 (sodium-glucose-transporter-2) inhibitors would be similarly beneficial in patients on antidepressant medications alone.Methods: In this retrospective cohort study, we included all patients with type 2 diabetes on antidepressant medications referred to our endocrine clinics between January 1, 2016, and January 1, 2017. Overall, 61 patients were started on a GLP-1 analog, 9 patients were started on an SGLT-2 inhibitor, and 134 were on alternative regimens (controls).Results: The groups did not differ in age, sex, ethnicity, and glycosylated hemoglobin (HbA1c) levels, although body mass index levels were higher in patients started on a GLP-1 analog (P < .0001). After 12 months, patients on GLP-1 analogs lost 4 kg, patients on SGLT-2 inhibitors lost 2.4 kg, and controls gained 0.8 kg (P < .001 for controls versus GLP-1 analog group). Subanalyses revealed that GLP-1 analog-related weight loss was most notable in women and patients on selective serotonin reuptake inhibitors. On the other hand, all serotonin-norepinephrine reuptake inhibitor users lost weight over time, independent of the antidiabetic regimen applied. In contrast to the above noted differences in weight control, HbA1c reductions were comparable and somewhat diminished in all patients on antidepressant medications (-0.3% to 0.6%).Conclusions: In this retrospective cohort study, we confirm superiority of GLP-1 analogs in mediating weight loss in patients on psychotropic and, more specifically, antidepressant medications. We also note overall blunted glycemic improvements in patients on antidepressant medications, a finding that was independent of the treatment strategy used. It could be a result of mental distress or suboptimal self-care and clearly requires further attention by future, prospective studies.