Overweight and obesity are defined as an excessive accumulation of fat that can be harmful to health, while diabetes is a chronic metabolic disease characterized by high blood glucose levels, according to the World Health Organization (WHO). Endocrinologists consider this pathology to be the pandemic of the 21st century, as type 2 diabetes is constantly increasing worldwide.
Type 2 diabetes is the most common type of diabetes mellitus and consists of the body presenting resistance to insulin, a hormone produced by the pancreas that acts as a key for glucose to enter the cells and be used as energy. In other words, the body does not produce this hormone or does not use it correctly. Causes include overweight and obesity, lifestyle, and hereditary factors.
The treatment is based on controlling blood sugar levels and the medications are usually oral and injectable. Some of them are related to weight loss, which is why they have become more popular, so much so that many people without a diagnosis of diabetes use them only to control overweight or obesity.
In 2017, the U.S. Food and Drug Administration (FDA) approved the Wegovy injection, which includes the compound semaglutide under the name “Ozempic,” for chronic weight control in overweight or obese adults with at least one weight-related condition, such as high blood pressure, type 2 diabetes, or high cholesterol, for use in conjunction with a reduced-calorie diet and increased physical activity.
A study to test its effectiveness involved nearly 2,000 people and showed an average weight loss of 15kg over the 15-month trial. It has therefore been hailed as a “new era” in the treatment of obesity, the BBC reports.
In recent weeks, the results of this drug have become popular worldwide, especially through the social network TikTok, where Internet users have posted thousands of videos talking about the “miracle” drug that would help people lose weight quickly. Since October 2022, several pharmacies in Spain and other countries have reported a shortage of the drug Ozempic due to high demand.
Given this popularity, diabetes specialists comment on the relationship between diabetes medications and weight loss.
Metformin
“Type 2 diabetes medications are used for weight loss worldwide. One of these is metformin, although it is considered a weight-neutral drug. It has been suggested that insulin resistance creates an environment that allows a higher percentage of caloric content to be stored in the form of fat, so the medication lowers this level of resistance and could indirectly lead to weight loss. However, it is not a medication used for the latter,” explains Francis Ruiz, an endocrinologist from Costa Rica.
Although metformin may change the way the body stores body fat, weight loss will depend on the person and their lifestyle. Also, the results may only be seen while the drug is being taken.
SGLT2 inhibitors
Among the variety of medications used to control diabetes, two groups have begun to be used for weight control. One of them is the sodium-glucose cotransporter type 2 (SGLT2) inhibitors, which include canagliflozin (Invokana), ertugliflozin (Steglatro), dapagliflozin (Farxiga) and empagliflozin (Jardiance), which have been shown to cause modest weight loss.
“This group of drugs blocks a receptor in the kidney. Glucose that comes into the bloodstream is filtered in the kidney and normally this organ reabsorbs it, but by blocking this step a higher percentage of glucose is eliminated in the urine, which causes calories to be lost through the urinary tract. This promotes weight loss,” explains Ruiz.
Risks
In 2015, the U.S. Food and Drug Administration (FDA) warned that the drugs canagliflozin, dapagliflozin, and empagliflozin can cause ketoacidosis, a serious condition characterized by elevated levels of ketones in the blood. “We are continuing to investigate this safety issue and will determine whether changes to the prescribing information for this class of drugs are needed,” the statement said.
The doctor also indicates that SGLT2 is related to the increase in mild and severe genitourinary infections. Also to Fournier’s gangrene, which is a very severe infectious process at the genitourinary level.
Semaglutide (GLP-1 agonists)
The other group is the glucagon-like peptide-1 (GLP-1) agonists, which include Dulaglutide (Trulicity), Exenatide (Byetta, Bydureon Bcise), Liraglutide (Saxenda, Victoza), Lixisenatide (Adlyxin), and Semaglutide (Ozempic, Rybelsus, Wegovy).
Two drugs in this family have been specifically investigated for obesity control, regardless of whether the patient has diabetes or not. Semaglutide and Liraglutide, at appropriate doses, have an official indication for weight control.
“These drugs have two approved indications for use: diabetes control and weight loss. The reason they help us lose weight is that they have an effect of increasing satiety; patients who use them eat less because they feel full faster,” explains Sergio Ramirez Ortiz, an endocrinologist and member of the Association of Endocrinology, Metabolism and Nutrition.
The Mayo Clinic website indicates that some studies have found that all glucagon-like peptide-1 drugs can cause weight loss of between 10.5 and 15.8 pounds when taking liraglutide; while those taking semaglutide and making lifestyle changes lose about 33.7 pounds.
“These drugs mimic the action of a hormone called glucagon-like peptide 1. When blood glucose levels start to rise after eating, they stimulate the body to produce more insulin. The extra insulin helps lower blood glucose levels,” says the Mayo Clinic. However, it is not known exactly how these types of drugs help with weight loss.
Endocrinologist Ramirez Ortiz believes that GLP-1 agonists should be considered as an aid that makes lifestyle changes easier. In addition to weight loss, the drugs help patients at high risk or with already diagnosed cardiovascular diseases to prevent new episodes of this pathology or its worsening.
Risks
The disadvantage of GLP-1 drugs is that all but one are administered by injection. They are also associated with pancreatitis and gastrointestinal discomfort such as nausea, vomiting, and diarrhea; and the dosages for weight loss and diabetes control are different, so it is recommended that they are always used under medical prescription.
“Semaglutide injection may increase the risk of developing thyroid gland tumors, including medullary thyroid carcinoma (MTC; a type of thyroid cancer),” MedlinePlus says.
Endocrinologists emphasize that these medications must be accompanied by lifestyle changes, such as a balanced diet and physical activity, to achieve better results, both for weight loss and for diabetes.
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