Is this the end of intensified insulin therapy and obesity in light of updates with novel medicines?

Abstract

Introduction: Modern times witness an increased prevalence of obesity and diabetes mellitus. While patients are offered a plan for blood glucose regulation, possible obesity issues, unfortunately, remain ignored. Blood glucose regulation inevitably deteriorates over time in diabetic patients that gradually gain weight.
 Material and Method: We recruited 42 diabetic patients who applied to our internal medicine outpatient clinic to investigate the impacts of two new generation therapies, sodium-glucose co-transporter-2 inhibitor (SGLT-2i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), on weight. Six patients were excluded from follow-up for various reasons, and the study was finalized with 36 patients. The patients were followed up regarding body mass index (BMI), HbA1c levels, and insulin cessation or dose reduction.
 Results: We stopped insulin in 20 of 36 patients who started to receive SGLT-2i and GLP1-RA, while the insulin dose was reduced in the remaining patients. While the mean basal HbA1c level of the first group with insulin cessation was 9.13% (min-max: 6.4-14), it was recorded as 7.63% (min-max: 5, 2-10,8) in the sixth month of treatment modification (p < 0.001). Despite a slight HbA1c increase in two patients, we concluded a significant decrease in HbA1c levels in 18 patients. Altogether, these 20 patients experienced an average of 1.5% HbA1c reduction.
 The findings also revealed that the mean basal BMI value (38.99 kg/m2; min-max: 33.2-43.4) among these 20 patients significantly decreased to 38.13 kg/m2 (0.86 kg/m2) in the sixth month of treatment modification. Among eight patients with reduced insulin and HbA1c level, the mean BMI value changed from 43.05 kg/m2 (min-max: 38.3-52.5) to 40.91 (min-max: 38.1-50) at the sixth-month follow-up. In this case, we may assert that losing weight has a positive impact on blood glucose regulation. However, it changed from 34.87 kg/m2 (min-max: 30.6-38.2) to 35.77 kg/m2 (min-max: 31. 8-39.1) among the other eight patients with reduced insulin but unreduced HbA1c.
 Conclusion: Overall, we believe that SGLT-2i and GLP1-RA, with significant benefits in both cardiovascular protection and weight control, would be more advantageous when used more frequently in obese patients without obvious contraindications since they rarely cause hypoglycemia and are easily tolerated