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Weight loss drugs offer promising solution for prediabetes compared with glucose-lowering methods
LAS VEGAS — In looking at the population of patients classified as prediabetic, one expert here suggested that antiobesity medications may have a more preventive effect on the transition to overt diabetes than traditional antihyperglycemic drugs.
“Typically, one thinks of antihyperglycemic therapies in the prediabetic patient. ... A more promising area for normalizing glycemia are the pharmacologically assisted weight loss interventions, which are beginning to produce extremely outstanding remissions in prediabetes and prevention to overt type 2 diabetes,” Alan J. Garber, MD, chief medical editor for Endocrine Today, said during his presentation at the AACE 23rd Annual Scientific & Clinical Congress. “Perhaps antiobesity therapies are a better approach for patients since it gets more to [the] etiology of the underlying deterioration of beta-cell function.”
Garber presented the American Association of Clinical Endocrinology’s algorithm for treating type 2 diabetes, and explained that this treatment begins with the patient with prediabetes, and is dependent upon a person’s metabolic complications due to their overweight or obesity.
“The algorithm is really an attempt to move beyond the glucose-centric view of the patient with diabetes and take a holistic view of what’s happening to this patient. And it includes the patients with prediabetes and obesity because ... there’s no question that the antecedent metabolic changes which set in motion the eventual outcome of type 2 diabetes must be recognized early on … before there is significant beta cell damage if one is to reverse the process,” Garber said. “In order to justify taking it up a notch to either pharmacologically-assisted weight loss or surgical interventions, one really should have some structured approach in mind based upon the number of complications.”
The currently available antiobesity medications, such as lorcaserin (Belviq, Eisai) and toparimate (Topamax, Janssen), have shown a 10% reduction in weight loss, according to Garber, and this reduction could “essentially rid most patients of their prediabetic states and prevent their deterioration to overt diabetes.”
These newer methods of addressing obesity are justified when a patient does not respond to traditional lifestyle modifications, he said.
“Strictly blood sugar lowering drugs ... will increasingly become passé as we develop more assertive ways of dealing with the underlying obesity that’s driving the deterioration to type 2 diabetes.”
For more information: Garber AJ. W22. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.
Disclosures: Garber reports financial relationships with Lexicon Pharmaceuticals, Merck & Co., Novo Nordisk, and Santarus.
Perspective
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When we consider optimal treatment of prediabetes and metabolic syndrome — because both of these conditions place individuals at high risk of progression to type 2 diabetes and are also associated with a number of cardiometabolic risk factors that predispose individuals to cardiovascular disease — there are options for treatment.
You could choose to add a diabetes drug like metformin to treat the dysglycemia. You could pick some antihypertensives to treat the hypertension. And you could pick some lipid-lowering drugs to address the dyslipidemia.
Or you could pick weight loss, which is sufficient to improve all of these parameters: both the dysglycemia and the cardiovascular disease risk factors at the same time.
We know that weight loss is highly effective at preventing the progression to type 2 diabetes. Of course, that was shown in the Diabetes Prevention Project, a lifestyle intervention that prevented diabetes by 58% as compared to placebo.
Recently, we published a paper using phentermine-topiramate extended release (Qsymia, Vivus) as an adjunct to lifestyle in reducing body weight in patients with metabolic syndrome or prediabetes at baseline compared to a lifestyle intervention plus placebo arm (Garvey WT. Diabetes Care. 2013;doi:10.2337/dc13-1518.). We observe that, over 2 years, the medicine-assisted weight loss reduced progression to diabetes by 79% compared to the lifestyle arm, which did achieve 2% weight loss.
Medicine assisted weight loss is highly effective at preventing diabetes and that weight loss is also associated with improvements in the cardiovascular risk factors.