One of the most daunting parts of managing patients with diabetes is preventing the weight gain that comes along with certain therapies. In this video, from our Diabetes Mellitus Masterclass course, you'll learn how to select a diabetes regimen that results in minimal weight gain for your patients.
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[00:00:00] A primary concern for many patients with type 2 diabetes is weight gain. Unfortunately, weight gain is a common side effect for many of our diabetes medications. So, when looking at different medication options for your patients, you'll often want to consider the risk of weight gain and select medications that minimize this or may even aid in weight loss. Again, metformin is going to be your first choice for nearly all patients with
[00:00:30] type 2 diabetes, including those concerned with weight. It's considered weight neutral and may actually cause weight loss in some patients. For patients concerned with weight gain, lifestyle intervention is important to emphasize as well. As with all patients with type 2 diabetes, you want to reassess glycemic control after three months of therapy. If glucose goals are not met after three months of metformin, we need to add a second medication. If you're looking to minimize weight gain, the best options are the DPP-4
[00:01:00] inhibitors, the SGLT-2 inhibitors or the GLP-1 receptor agonists. The DPP-4 inhibitors are weight neutral so will limit weight gain but often patients concerned with weight, up for medication that can cause weight loss, either the GLP-1 receptor agonists or the SGLT-2 inhibitors. In this case, I will generally choose the GLP-1 receptor agonists for patients who are okay with injections or the SGLT-2 inhibitors for patients who would prefer an oral medication.
[00:01:30] The primary side effect with the GLP-1 receptor agonists is nausea, while the SGLT-2 inhibitors can cause increased urination, vaginal yeast infections or urinary tract infections, which can be bothersome for some patients. The DPP-4 inhibitors are generally well tolerated but not as effective as the other two medications. If blood sugars aren't at goal three months after introducing the second medication, the third step of the treatment algorithm is further
[00:02:00] intensification with a third agent. Again, for patients whose primary goal is minimizing weight gain, you will want to choose either an incretin or an SGLT-2 inhibitor. These medications work well in combination due to their different actions to lower blood sugars. If your patient cannot achieve their A1c goals on three non-insulin agents, you will need to consider starting insulin. Unfortunately, nearly all patients will gain weight on insulin but with
[00:02:30] continued efforts at diet and lifestyle, you can minimize this while improving glucose control.