Diabetes and obesity are mostly overlapping epidemics and both are inextricably linked to many of the most common chronic illnesses like hypertension, hyperlipidemia, heart disease, sleep apnea, chronic kidney disease. Doctors in different specialties are routinely treating diabetes in their practice but only a small percentage has received formal education in the co-management of diabetes and obesity. Given the relationship between the pathogenesis of obesity and type 2 diabetes mellitus (T2DM) as well as their significant health consequences, treatment strategies that can induce weight loss while achieving glycemic control are needed. This session will provide an overview of the role of current and emerging anti-obesity medications in a weight centric approach to the treatment of diabetes and diabetes associated comorbidities. It will summarize and compare weight loss efficacy and glycemic control of weight-reducing anti-diabetic medications, AOMs and emerging pharmacologic agents that help treat both obesity and T2DM. It will highlight the main obesity clinical trials in type 2 diabetes, the available clinical practice guidelines, the off the press clinical studies and the relevant post marketing data. In general, weight loss in patients with diabetes is challenging and this is particularly notable in obesity pharmacotherapy trials, in which weight losses are commonly 25% lower in patients with obesity and diabetes than in patients with obesity but without diabetes. Likely genetic, metabolic and environmental factors play a role but perhaps the most relevant contributor, and one that can be readily addressed in clinical practice is the use of medications that contribute to weight gain. Iatrogenic weight gain due to medications utilized in patients with diabetes will be reviewed. The session will then review the efficacy, safety and dosing of current and emerging AOMs in diabetes and complications and will offer a case-based, practical guide on how to choose the best medication for these special populations. Finally, it will discuss the precautions and prescribing considerations of AOMs in diabetes, specifically the risk of hypoglycemia, and suggest a protocol to reduce the risk of hypoglycemia in weight loss.
1. Learning objectives
2. Burden of obesity and diabetes: parallel epidemics
3. Burden of diabetes associated comorbidities
4. Weight loss in diabetes, benefits and challenges
5. Effects of antidiabetic medications on weight
6. Other drug induced weight gain
7. In diabetes, should be treat obesity first?
8. Benchmark of diabetes care, effect of AOMs on those benchmarks
9. Review of the available weight loss medications
10. Obesity as a contributor of CKD in diabetes, pathophysiology, weight loss in CKD
11. Anti-obesity medications and benefit of weight loss in diabetic nephropathy
12. Cardiovascular outcome trials with AOMs, effect of AOMs on CV risk factors
13. Additional pharmacotherapy with weight loss benefits in DM, argument for combination therapy
14. Adjust antidiabetic medications in weight loss
15. Where are we going? The next generation of AOMs and what do they mean for clinical practice in diabetes?
16. Putting it all in action: conclusions and clinical pearls