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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- National Estimate of Diabetes and Its Burden to the United States.2021 (Accessed on August 3)
- 10 Facts on obesity.2016 (Accessed on February 20, 2019)
- Management of overweight and obesity in adults: behavioral intervention for long-term weight loss and maintenance.Eur J Cardiovasc Nurs. 2006; 5: 102-114
- Obesity: risk factors, complications, and strategies for sustainable long-term weight management.J Am Assoc Nurse Pract. 2017; 29: S3-S14
- Savings in Medical expenditures associated with reductions in body mass index among US adults with obesity, by diabetes status.Pharmacoeconomics. 2015; 33: 707-722
- Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic.Obesity (Silver Spring). 2008; 16: 23-30
- Treatment satisfaction with different weight loss methods among respondents with obesity.Clin Obes. 2016; 6: 161-170
- 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
- 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults.Circulation. 2014; 25: S1-S45
- Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes—2021.Diabetes Care. 2021; 44: S100-S110
- Anti-obesity medication use in 2.2 million adults across eight large health care organizations: 2009-2015.Obesity. 2019; 27: 1975-1981
- Anti-obesity medication use across the Veterans Health Administration: patient-level predictors of receipt.Obesity (Silver Spring). 2014; 22: 1672-1968
- National Health and Nutrition Examination Survey: analytic guidelines, 1999-2010.Vital Health Stat. 2013; 2: 1-24
Article Info
Publication History
Published online: January 29, 2022
Accepted:
January 6,
2022
Identification
Copyright
© 2022 Elsevier Inc.
