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Prevalence of Antiobesity Treatment and Weight-Inducing Antihyperglycemic Agents Among Patients With Type 2 Diabetes in the United States

      ABSTRACT

      Purpose

      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 loss therapy.

      Methods

      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.

      Findings

      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).

      Implications

      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.

      Key words

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      References

        • National Diabetes Statistics Report 2020
        National Estimate of Diabetes and Its Burden to the United States.
        2021 (Accessed on August 3)
        • World Health Organization (WHO)
        10 Facts on obesity.
        2016 (Accessed on February 20, 2019)
        • Lang A
        • Froelicher E.
        Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance.
        Eur J Cardiovasc Nurs. 2006; 5: 102-114
        • Fruh M.
        Obesity: risk factors, complications, and strategies for sustainable long-term weight management.
        J Am Assoc Nurse Pract. 2017; 29: S3-S14
        • Cawley J
        • Meyerhoefer C
        • Biener A
        • et al.
        Savings in Medical expenditures associated with reductions in body mass index among US adults with obesity, by diabetes status.
        Pharmacoeconomics. 2015; 33: 707-722
        • Wang Y
        • Beydoun MA
        • Liang L
        • et al.
        Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic.
        Obesity (Silver Spring). 2008; 16: 23-30
        • Gupta S
        • Wang Z.
        Treatment satisfaction with different weight loss methods among respondents with obesity.
        Clin Obes. 2016; 6: 161-170
      1. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health.
        Obes Res. 1998; 6: 51s-209s
        • Jensen M
        • Ryan D
        • Apovian C
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults.
        Circulation. 2014; 25: S1-S45
        • American Diabetes Association
        Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes—2021.
        Diabetes Care. 2021; 44: S100-S110
        • Saxon DR
        • Iwamoto SJ
        • Mettenbrink CJ
        • et al.
        Anti-obesity medication use in 2.2 million adults across eight large health care organizations: 2009-2015.
        Obesity. 2019; 27: 1975-1981
        • Del Re AC
        • Frayne SM
        • Harris AHS
        • et al.
        Anti-obesity medication use across the Veterans Health Administration: patient-level predictors of receipt.
        Obesity (Silver Spring). 2014; 22: 1672-1968
        • Johnson CL
        • Paulose-Ram R
        • Ogden CL.
        National Health and Nutrition Examination Survey: analytic guidelines, 1999-2010.
        Vital Health Stat. 2013; 2: 1-24