Hello, today we will deal with diabetic medications that can affect
the weight of the patient. We will divide antidiabetic
medications into 3 groups. The first group are antidiabetic
medications that can cause weight loss, this is something positive for all diabetic patients,
since most of diabetes type 2 patients are obese. I will list the medications in decreasing order of
glycemic efficacy, this means that the medications that I am saying the first are having the best
glycemic efficacy, meaning they are the most efficient in decreasing glucose in the blood.
So the first group of medications can cause weight loss and these are: GLP-1 agonists,
Pramlintide and SGLT2 inhibitors. The second group are those that are weight
neutral, namely Metformin, DPP-4 inhibitors and Alpha glucosidase inhibitors.
The third group are those that can cause weight gain, namely Insulin,
Sulfonylurea, glinides and Thiazolidinedione. We can say that the first group has a very big
advantage, GLP-1 agonists, Pramlintide and SGLT2 inhibitors all can cause weight loss.
This means that out of the first group the GLP-1 agonists has the highest glycemic efficacy
and also causes weight loss. This does not mean that GLP-1
agonists has the highest glycemic efficacy from all of the diabetic medications.
The actual antidiabetic medication that has the highest glycemic efficacy is insulin.
Let us look at the antidiabetic medications in decreasing order of glycemic efficacy: Insulin,
Metformin, Sulfonylurea, GLP-1 agonists, Glinides, Thiazolidinedione, Pramlintide,
DPP-4 inhibitors, Alpha glucosidase inhibitors and SGLT-2 inhibitors.
Out of this list we can see that the medications causing weight loss are GLP-1 agonists having the
fourth highest glycemic efficacy, Pramlintide being in the middle and SGLT-2 inhibitors
actually having the lowest glycemic efficacy. So in one hand SGLT-2 inhibitors are very good
since they cause weight loss but on the other hand they have a very low glycemic efficacy
compared to the other medications. GLP-1 agonists cause weight loss
and also has a very high glycemic efficacy. What about the best glycemic efficacy medication,
namely insulin? Insulin cause weight
gain, which is a disadvantage. Metformin on the other hand
which has the second highest glycemic efficacy, is actually weight neutral. Therefore one can
say that Metformin is the best medication since it has a very high glycemic efficacy together
with no change in the weight of the patient. What about the other 2 medications that are
weight neutral?, Namely DPP-4 inhibitors and alpha glucosidase inhibitors.
These have also fairly low glycemic efficacy. One can say that GLP-1 agonists and
Metformin are the best choice when choosing antidiabetic medications
since they both have high glycemic efficacy and are weight neutral or weight loss medications.
This does not mean that the medication is causing weight gain cannot be used, in fact
this group of medications has one of the highest glycemic efficacy.
Insulin has the highest, Sulfonylurea is in the third place, glinides in the fifth place and
Thiazolidinedione in the sixth place. Let us refresh our memory.
The antidiabetic medications with the highest glycemic efficacy listed in decreasing order are:
Insulin, Metformin, Sulfonylurea, GLP-1 agonists, Glinides, Thiazolidinedione,
Pramlintide, DPP-4 inhibitors, Alpha glucosidase inhibitors and SGLT-2 inhibitors.
Now lets regroup them into 3 groups. The first group that are weight loss
medications are: GLP-1 agonists, SGLT-2 inhibitors, and Pramlintide.
The second group that are weight neutral are: Metformin, DPP-4 inhibitors and
Alpha glucosidase inhibitors. The third group that are weight
gain medications are: Insulin, Sulfonylurea, Thiazolidinedione and Glinides.
I thank you very much for listening take care bye-bye.