Nearly 90% of individuals with type 2 diabetes mellitus (T2DM) are either overweight
or obese, placing them at high risk of microvascular and macrovascular complications.
The main objective of this study was to assess the use of antiobesity medications
and antihyperglycemic agents that produce weight gain among patients with T2DM who
qualify for National Institutes of Health guideline–recommended pharmacologic weight
This study used the 2005–2006 through 2015–2016 biannual cycles of the National Health
and Nutrition Examination Survey and included adults aged ≥20 years who reported a
diagnosis of T2DM and who qualified for antiobesity treatment (defined as a body mass
index ≥27 kg/m2) at the time of physical examination. Antiobesity medication use was defined as use
of orlistat, phentermine, diethylpropion, lorcaserin, phentermine/topiramate, bupropion/naltrexone,
or liraglutide. Use of weight-inducing antihyperglycemic agents was defined as use
of sulfonylureas, thiazolidinediones, or insulin (any type), either alone or in combination
with any other antihyperglycemic agent regardless of effect on weight.
Among adults with T2DM who qualified for antiobesity treatment (N = 2910), only 40
participants (2.2%; 95% CI, 1.5–3.3) were on pharmacologic antiobesity treatment within
30 days of survey interview. The only antiobesity medications identified were liraglutide
(n = 34 [1.9%]), phentermine (n = 4 [0.2%]), orlistat (n = 1 [0.1%]), and phentermine/topiramate
(n = 1 [0.0%]). Among those who were on antihyperglycemic treatment (n = 2401), 1661
(66%; 95% CI, 63.1–68.8) were on weight-inducing antihyperglycemic agents; however,
a downward trend in the use of these agents over time was observed (from 78.4% in
2005–2006 to 53.3% in 2015–2016; P < 0.0005).
This is the first national epidemiologic study evaluating the use of antiobesity medications
and weight-inducing antihyperglycemic agents among patients with T2DM who qualify
for weight loss therapy. This study documents that patients are not on guideline-directed
weight loss therapy. Furthermore, weight loss goals are likely compromised by 66%
of individuals being on weight-inducing antihyperglycemic therapy. Use of antiobesity
medications could play a significant role in promoting weight loss and potentially
lead to a healthier lifestyle, which could reduce microvascular and macrovascular
complications. Stronger recommendations in using guideline-directed therapy in obesity
complicated by T2DM are necessary.