Fast Five Quiz: Type 2 Diabetes and Obesity and Weight Management

Anne L. Peters, MD; Romesh Khardori, MD, PhD


February 22, 2023

When glycemic control is not achieved with a single glucose-lowering agent, an additional medication can be added, but the impact of each medication on weight should be considered when choosing the most appropriate glucose-lowering therapies. Studies have demonstrated that in addition to improving glucose and providing primary prevention for CVD, weight loss was consistently observed in patients taking GLP-1 RAs. In addition, when combined with intensive lifestyle modifications, high doses of GLP-1 RAs dulaglutide and semaglutide may be used to induce weight loss and are considered to have a very high efficacy for glucose lowering.

While GLP-1 RAs and SGLT2 inhibitors both promote weight loss, GLP-1 RAs are recommended in patients with obesity and overweight with weight-related comorbidities, and even in people without type 2 diabetes. GLP-1 RAs are an effective weight loss medication in many settings, with a greater reduction than is seen with SGLT2 inhibitors. This class is considered to have a high efficacy with regard to A1c reduction, making it an alternative to insulin in some cases.

SGLT2 inhibitors are recommended in patients with established CVD and have shown significant benefit in patients with type 2 diabetes and HF, CVD, and/or CKD. This class of agents has been shown to have an intermediate efficacy in regard to A1c lowering. They do not cause hypoglycemia.

Learn more about management guidelines for type 2 diabetes.


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