Most patients diagnosed with type 2 diabetes are above their ideal weight. Excess weight, particularly around the waist, is a major cause of insulin resistance, a condition in which the body does not use insulin effectively causing glucose to build up in the blood instead of being absorbed by the cells. Over time, insulin resistance can lead to type 2 diabetes.
Losing weight greatly reduces the risk of developing type 2 diabetes and can help bring blood glucose under control in individuals who already have the disease. Individuals with type 2 diabetes who are overweight or obese are at increased risk of developing complications. Losing just a few pounds through exercise, eating well and taking the right medications can help control diabetes and reduce the risk for other health problems.
Some diabetes medications not only lower blood glucose but also have the added benefit of promoting weight loss. One of the common findings in early type 2 diabetes is hyperinsulinemia, a condition in which the pancreas secretes large amounts of insulin to counter insulin resistance to keep blood glucose within normal range. Insulin has been shown to act on the brain and produce hunger or stimulate appetite. Metformin prevents the pancreas from secreting too much insulin by increasing the body’s sensitivity to insulin and suppressing the release of glucose from the liver, thereby preventing blood glucose levels from rising too high and lowering appetite.
Liraglutide is a once-daily injectable medication for adults with type 2 diabetes mellitus that provides substantial reduction in HbA1c, a key measure of blood glucose control. It also has the added benefit of promoting weight loss by reducing appetite. Marketed under the brand name Victoza, it mimics the action of an intestinal hormone called GLP-1 that stimulates the beta cells in the pancreas to release insulin when blood sugar is too high after meals. GLP-1 also helps lower the amount of glucose produced by the liver.
A new study has shown that this innovative medication can induce and maintain weight loss in people who are obese or overweight with type 2 diabetes. The study involved 846 type 2 diabetes patients with an average weight of 106 kilograms (234 pounds) and mean BMI or body mass index of 37 (normal BMI range for adults is 18 to 24.9). Subjects were randomized 2:1:1 to receive liraglutide 3 mg and 1.8 mg or placebo in combination with diet modification and exercise.
After 56 weeks, subjects given the once-daily medication achieved an average weight loss of about 6 percent compared to 2 percent for those given placebo. More subjects on the medication achieved substantial weight loss compared to those on placebo. Starting from a baseline HbA1c of 8 percent, almost 70 percent of subjects treated with liraglutide achieved the HbA1c treatment target of 7 percent compared to 27 percent of subjects given placebo.
This study showed that it is possible to achieve both clinically significant weight loss and excellent glucose control with a single treatment in overweight or obese patients with type 2 diabetes.
DIABETES TRIVIA CONTEST: GLP-1 is a hormone secreted by the small intestine that helps stimulate insulin secretion. True or False? E-mail your answer to firstname.lastname@example.org and get a chance to win a prize! Congratulations to Boyet Ignes! Your correct answer to the question in the July 20, 2013 column was chosen as this week’s winner in the Diabetes Trivia Contest. You will receive an e-mail on how to claim your prize.
Dr. Sjoberg A. Kho is a board-certified endocrinologist. The 7“Changing Diabetes” column commemorates the 92nd anniversary of insulin’s discovery. It aims to increase awareness on diabetes prevention, diagnosis and management. Novo Nordisk supports “Changing Diabetes.” Headquartered in Denmark, Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. For questions or comments, e-mail email@example.com.