Addressing excess weight should be a central focus for T2D management1
Diet and lifestyle are key to addressing excess weight, however, pharmacotherapy should also be considered to help people living with diabetes achieve their health goals1
When choosing glucose-lowering therapies for a patient with excess weight, like Ahmed, consider a regimen with high to very high glucose lowering and weight loss efficacy; this may include*:
Moderate Exercise1
Nutritional Changes1
Consistent Sleep Patterns1
Medication for Weight Management (as an adjunct to behavioral changes)1
*Discussion of metabolic surgery deferred as it does not apply to patient case.
The ADA-EASD Consensus Report recommends medications for glycemic control and weight management as adjuncts to lifestyle intervention1
When choosing glucose-lowering therapies, consider a regimen with high to very high glucose and weight efficacy1
The graphic shows the recommendations for achieving and maintaining glycemic targets and weight goals from the ADA Standards of Care 2024.
Blood sugar control: Choose effective strategies to achieve treatment goals. Metformin or other agents (including combination therapies) with adequate efficacy for achieving and maintaining treatment goals are suitable. In high-risk patients, special emphasis should be placed on avoiding hypoglycemia. The higher the effectiveness of the strategy, the more likely it is to achieve glycemic targets. Dulaglutide (high dose), semaglutide, tirzepatide, insulin, oral combination therapy and injectable combination therapy (GLP-1-RA)/insulin have very high effectiveness. GLP-1-RA (not mentioned above), metformin, SGLT2 inhibitors, sulfonylureas and glitazones have high effectiveness. Intermediate effects are provided by DPP-4 inhibitors.
Achieving and maintaining weight goals: Set individual goals for weight management. Provide general lifestyle advice, e.g. medical nutrition therapy/eating behavior/exercise. Use an intensified, evidence-based, structured weight management program. Consider drug therapies for weight reduction. Consider metabolic surgery. When choosing blood sugar-lowering therapies, consider a strategy with high to very high effects on blood sugar and weight. Semaglutide and tirzepatide have very high effects on weight reduction. Dulaglutide and liraglutide have high effects. GLP-1 RAs (not mentioned above) and SGLT2 inhibitors have intermediate effects. The effect of DDP-4 inhibitors is neutral.
Adapted from Davies MJ, et al.
ADA-EASD consensus report1:
“Weight loss of 5%-10% confers metabolic improvement; weight loss of 10%-15% or more can have a disease-modifying effect and lead to remission of diabetes.”
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