The role of anti-obesity drugs in the management of obese diabetics

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Obesity contributes to type 2 diabetes and worsens its control. 5-10% weight loss among obese diabetics significantly improves glucose control, lipids and blood pressure. Weight loss should be a key goal of diabetes care for all overweight and obese patients with type 2 diabetes. Adjunctive therapy with weight loss drugs is indicated among obese diabetics who can not achieve weight maintenance with lifestyle alone. Metformin use is associated with weight loss during management of diabetics. Metformin may reduce BMI by 5.3 % in comparison with placebo and it is considered as first-line agent in obese patient with type 2 diabetes. SGLT-2 inhibitors may reduce body weight for 3 to 5 kg during management of type 2 diabetes. Orlistat use resulted in a significant reduction of cumulative incidence of type 2 diabetes after 4 years of treatment of obese subjects. Phentermine and topiramate combination use in patients with diabetes and prediabetes results in greater reduction in HbA1c values and fewer prediabetes patients progression to type 2 diabetes. Therapy with combination of bupropione and naltrexone sustained-release among diabetic patients with obesity resulted in reduction of HbA1c and improvements in triglycerides and HDL cholesterol values. In BLOOM-DM study lorcaserin decreased weight by 4.5-5 % together with reductions in HbA1c . Liraglutide has a therapeutic potential for both obesity and type 2 diabetes, due to its dual benefits on body weight and glycemic control. Semaglutide is a new GLP-1 analogue that reduces HbA1c and body weight and improves obesity related complications. Combination of GLP-1/glucagon dual agonist theoretically may decrease food intake and body weight according the preclinical experience. In case where patient does not lose 5 % or more of his body weight on prescribed drug, after three months of treatment, therapy with this drug should be stopped and changed with some other.