Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers.
A predominant risk factor for type 2 diabetes is being overweight or obese, so weight loss goals while maintaining normal blood sugar levels are very important for some patients. In addition to lifestyle modifications, medications for type 2 diabetes may aid in losing weight.1,2
Obesity
Obesity is defined as a body mass index (BMI) of 30 kg/m2 or higher and is associated with many major health issues including cardiovascular disease, osteoarthritis, and type 2 diabetes. A weight loss of 5% to 15% can improve obesity-related complications.1,2
There are approved medications to help treat obesity, including phentermine (Lomaira®), orlistat (Alli®), topiramate (Trokendi XR®), and naltrexone/bupropion (Contrave®). However, these are not indicated to treat type 2 diabetes.3
Type 2 Diabetes
Type 2 diabetes is a chronic disease due to a progressive loss of insulin secretion and/or increased insulin resistance. As a result, the body’s naturally produced insulin becomes less effective in reducing the amount of sugar in your blood. Excess weight or excess percentage of body fat can cause some degree of insulin resistance. Most, but not all, patients with type 2 diabetes have overweight or obesity.
Different antidiabetic medications work through different mechanisms to help lower blood sugar. Some of these medications also provide additional benefits for patients, including weight loss. The medications with weight loss benefits include metformin, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and glucagon-like peptide-1 (GLP-1) receptor agonists.2
Type 2 Diabetes Medications That Induce Weight Loss
The following is a list of FDA-approved medications for the management of type 2 diabetes that may also result in weight loss. It is important to note that the amount of weight loss can vary depending on the medication, dose, duration of therapy, and lifestyle changes. Speak with your provider to know additional information.
Simulates GLP-1 receptors to increase insulin secretion and decrease glucagon secretion14
Nausea Vomiting Diarrhea Acute kidney injury Injection site reactions24
Weight Loss Differences
Biguanides
In a long-term study, patients who took metformin maintained an average weight loss of 6.2% between 6 and 15 years of treatment. Patients who experienced greater long-term weight loss were those who (1) lost more weight during their first year of treatment, and (2) were older in age.5,6
SGLT2 Inhibitors
Various studies demonstrate long-term weight loss effects among patients taking SGLT2 inhibitors. In an analysis of multiple studies, patients had an average weight loss of between 1.5 kg and 2 kg after 4 years of treatment. These effects increased with increasing doses of these medications. Other studies have revealed average weight loss percentages between 2.2% and 3.3% of patients’ starting weight.5, 10-12
Other studies show improved weight loss among patients combining SGLT2 inhibitors with other drugs, such as metformin or GLP-1 receptor agonists. SGLT2 inhibitors may therefore be the drug of choice for patients also with heart and kidney disease.22,23 However, low blood sugar is more likely to occur when they are used as add-ons rather than used alone.30
GLP-1 Receptor Agonists
Studies report a wide range of weight loss effects associated with GLP-1 receptor agonists, from 1 kg to 15 kg depending on the medication.15-21 Weight loss effects depend on dose and treatment durations.5
Like SLGT2 inhibitors, GLP-1 receptor agonists can be used as add-on therapies for patients with heart and kidney disease, but low blood sugar is more likely to occur. 22, 23, 30
Frequently Asked Questions
Can I eat anything I want while on these medications?
No, food choices still play a significant role in diabetes management.
Different types of diets for patients with diabetes include Mediterranean, low-fat, low-carb, vegetarian, and vegan diets. Additionally, the Dietary Approaches to Stop Hypertension (DASH) approach could prevent more serious complications such as heart or kidney disease among those who have or are at risk for high blood pressure and high cholesterol.22,23
Diet modifications can also enhance natural GLP-1 and insulin production/sensitivity and prevent escalation of antidiabetic therapies while satisfying nutritional needs.24
Do I still have to exercise while on these medications?
Yes, it is recommended to engage in physical activity regularly, even if on medications that can result in weight loss, to prevent development and progression of heart- and kidney-related complications.
Patients with type 2 diabetes are advised to do 150 minutes per week of moderate to vigorous exercise or 75 minutes per week of high intensity exercise over a course of 3 or more days per week.25 Studies report that physical activity can contribute to increased effectiveness of certain medications, including GLP-1 receptor agonists and metformin.25-27
How can I prevent side effects such as nausea, vomiting, diarrhea, bloating, and constipation?
Metformin can cause an upset stomach on initial treatment so it should be taken with food. Note that these side effects should go away over time, so do not skip doses or stop taking metformin without speaking with your provider.7,8
The initial dose of a GLP-1 receptor agonist or SGLT2 inhibitor is typically low to prevent stomach issues but not high enough to help manage your blood sugar. For this reason, your provider may start you on a higher dose, but you should let them know if the stomach side effects become unmanageable for you.28,29
Can I be on multiple of these medications at the same time?
Yes, GLP-1 receptor agonists and/or SGLT2 inhibitors are preferred over other drug classes as add-on treatments to metformin, especially for patients at risk for heart or kidney disease, according to the American Association of Clinical Endocrinology and American Diabetes Association guidelines.
Before adding these medications, your doctor may consider factors such as heart and kidney disease, potential weight loss, and potential adverse effects.22,23 The use of GLP-1 receptor agonists with metformin may also exacerbate diarrhea.29
The Advisory Council on Alzheimer’s Research, Care, and Services presented updates on Alzheimer Disease (AD) and AD and related dementias (ADRD) treatments and ongoing AD research in a virtual meeting held in January.
Representatives from the National Alzheimer Project Act (NAPA) research committee, Washington University School of Medicine (WashU), and the Alzheimer’s Association reported on the developments in disease modifying therapies (DMTs), funding, resources for dementia caregivers, and the connection between AD and Down syndrome.1
DMTs for AD
From 2016 to 2023, researchers have observed advancements in AD treatment. Most recently, the US Food and Drug Administration (FDA) approved Leqembi (lecanemab), an amyloid beta-targeting antibody for patients with AD and those in the mild cognitive impairment (MCI) or mild dementia stage of the disease. The FDA’s decision on donanemab, also an amyloid beta-targeting antibody, for the treatment of patients with early AD, is anticipated in the first quarter of 2024.
The approved route of administration for lecanemab is intravenous (IV). Eisai Pharmaceuticals is testing a subcutaneous route of administration. Compared with the IV route, initial reports suggest that subcutaneous formulations clear 14% more plaque, have an 11% higher area under the curve (AUC), and have lower systemic injection reaction rates.2
On January 31, 2024, Biogen Inc. decided to discontinue Aduhelm (aducanumab-avwa) production, sales, and the affiliated clinical study. Instead, they will allocate their resources to the development of other treatment methods for AD and prioritize moving forward with lecanemab.3
Growing Resources for Dementia Caregivers
With recent progress in AD treatments, progress has also been made in the availability of resources for dementia caregivers. The Alzheimer's Association collaborated with the Centers for Disease Control and Prevention (CDC), Building Our Largest Dementia (BOLD) Public Health Center of Excellence on Dementia Caregiving, and Emory University to initiate a free interactive public health curriculum for clinicians, students, and educators. The goal is to increase awareness and knowledge about the importance of dementia caregiving and how public health may affect it.
Representatives of the advisory board addressed further initiatives concerning racial/ethnic diversity needs between patients and caregivers and demanded an increase in caregiver wage. Although a resolution has not been reached, caregiving networks are optimistic to find ways to implement changes in the near future.4
"
The research and the investments that have been made over the past decades led to these advancements in understanding the disease, how it starts and progresses, and figuring out ways to intervene in it.
Revisions and Updates to Funding AD Research
Various extensions and reauthorizations have been made to continue AD research. There is bipartisan agreement that AD research needs more attention. The National Institutes of Health (NIH) and the CDC are looking to:
Extend and reauthorize NAPA
Continue advising the Centers for Medicare and Medicaid Services (CMS) to implement a dementia care management model
In the senate budget requests for the 2024 fiscal year, the NIH requested a $321 million increase and the CDC requested $35 million for the BOLD infrastructure for the Alzheimer Act. The Act focuses on AD diagnosis, treatment, and dementia caregiving.5
Increases in federal funding have advanced AD research and the progression of clinical trials. “It’s research that changes the cookbook of medicine ... The research and the investments that have been made over the past decades led to these advancements in understanding the disease, how it starts and progresses, and figuring out ways to intervene in it,” Randall Bateman, MD, Charlotte and Paul Hagemann distinguished professor of neurology at WashU in St. Louis, said at the meeting.6
Challenges in AD Research
Researchers at WashU have identified challenges that have limited treatment objectives.7
Overall Barriers to AD Research
Racial & Ethnic Disparity
- Racial and ethnic groups are excluded from testing - Overall lack of research about patients with AD who belong to racial and ethnic groups
Accessibility to Infusion Centers
- Patients who live in rural areas have difficulty accessing infusion centers - Infusion treatments are time consuming. Patients often miss due to vacation, travel, and other illnesses. - 6–8-month waitlist for treatment - Small window for treatment
Cost of treatment
- Treatment costs $50,000 per year - Medicare finances only 80% of treatment expenses, which could leave patients with ~$10,000 bill out of pocket - AD biomarker testing is not offered insurance coverage
Effectiveness of DMTs
- Need for precision medicine for an individual's unique disease profile - Dosage and duration vary per patient - Some patients need to switch medications
Although limitations are presented in the infrastructure for AD/ADRD treatment, the researchers highlight initiatives for AD prevention. These include the early administration of lecanemab and the implementation of the combination of DMTs.8
The Connection Between AD and Down Syndrome
In highlighting the existing challenges with AD treatments, Elizabeth Head, MA, PhD, professor at the University of California, spoke about the connection between AD and Down syndrome (DS). By age 40, patients with DS have sufficient plaque and tangle pathology for an AD diagnosis. Dr Head mentioned that it is widespread for older patients with DS to develop AD, and it is one of the leading causes of death for this patient population.
Though there is a connection between AD and DS, patients with DS are often excluded from AD trials, presenting a barrier in research. Ultimately, there is a lack of racial and ethnic diversity in trials; only White patients have a higher survival rate.
Since there is still a limited amount of evidence, it is difficult to identify pharmacologic intervention effectiveness for cognitive decline in patients with DS. Dr Head urged that researchers should begin to expand AD studies to this patient population. The inclusion of patients with DS in cohort trials would result in advanced AD research and a better understanding of DS.9
Cybercrime targeting health care organizations is continuing its upward trend, and it is adversely affecting patient care and leading to a growing number of lawsuits.
In a 2023 survey of 653 health care IT and security specialists, 66% reported disruption to patient care, 57% reported poor outcomes due to delays in procedures and tests, and 50% reported an increase in medical procedure complications due to cyberattacks.
According to the report, 88% of health care organizations experienced an average of 40 attacks in the previous 12 months. The average total cost of a cyberattack was nearly $5 million, a 13% increase from the previous year.
These numbers suggest that health care organizations are making little progress in mitigating the risks of cyberattacks on patient safety and wellbeing. “Health care continues to be one of the most attacked industries” said Ryan Witt, vice president for industry solutions at Proofpoint, which is based in Sunnyvale, California. “The report also demonstrates that, in many cases, cyber events can adversely impact patient care by complicating procedures, extending hospital stays, and increasing the likelihood of patients having to be transferred to another facility. This is a material change for hospital executives who have frequently associated cybercrime with regulatory compliance, reputational harm, and financial harm.”
Supply chain attacks are the type of threat most likely to affect patient care, according to the report. Nearly two-thirds (64%) of surveyed organizations experienced a supply chain attack in the past 2 years. Among those, 77% experienced disruptions to patient care as a result, an increase from 70% in the previous year.
Non-compliance with HIPAA can lead to substantial civil monetary penalties (CMPs), which are designed to punish health care providers for not taking their responsibilities under HIPAA seriously. “The health care industry is experiencing a profound and unprecedented cybersecurity crisis,” said David Ting, founder and chief technology officer atTausight, a startup in Sudbury, Massachusetts, that focuses on reducing health care cyber incidents using a proactive, risk management philosophy. “I’m not surprised by the numbers. The reality is that the real numbers are probably higher because of smaller incidents being underreported.”
A business email compromise (BEC) is the type of attack most likely to result in poor outcomes due to delayed procedures (71%), followed by ransomware (59%), the Ponemon survey found. A BEC is also the most likely type of attack to result in increased medical procedure complications (56%) and longer hospital lengths of stay (55%).
“Breach activity within health care remains a significant concern,” Witt said. “Threat actors have become incredibly adept at attacking people on messaging platforms. These attacks are socially engineered meaning that the messages are often compelling, relevant, written in a style expected by the recipient, and often come from seemingly valid email addresses.”
Cyberattacks in 2023 put greater strain on resources compared with the previous year, costing on average 13% more overall and 58% more in the time required to ensure the impact on patient care was corrected, according to the report. Ransomware remains an ever-present threat to health care organizations: 54% of respondents said their organization suffered a ransomware attack, up from 41% in the previous year.
“Lately, we have been seeing patient-led class-action lawsuits becoming the norm, and unfortunately that seems to be the trend that is bringing more awareness that will lead to action,” Ting said. “Patients are now demanding health care institutions protect their privacy after feeling violated. We often see the most basic strategies being missed, and they are often the most important: cyber hygiene and data awareness.”
The number of surveyed organizations making a ransom payment dropped to 40% in 2023, down from 51% the previous year. However, the average total cost for the highest ransom payment jumped 29% to $995,450. Further, 68% said the ransomware attack resulted in a disruption to patient care, with most organizations (59%) citing delays in procedures and tests that resulted in worse outcomes.
All organizations surveyed had at least 1 data loss or exfiltration incident involving sensitive and confidential health care data within the past 2 years. “Patients and doctors should exercise caution when receiving unsolicited emails or text messages,” Witt said. “Be skeptical when it comes to identifying phishing in your email message. Obtaining user credentials is the nirvana state for would-be threat actors, and even an innocuous email can provide meaningful data that can be further exploited.”
Among organizations reporting data loss or an exfiltration incident, 46% experienced increased patient mortality rates and 38% had increased complications from medical procedures. Health care organizations feel most vulnerable to and most concerned about cloud compromise.
BEC/spoofing concerns increased significantly. The number of respondents concerned about BEC/spoofing jumped to 62% from the prior year’s 46%. More than half (54%) of organizations on average experienced 5 of these types of incidents. BEC/spoofing attacks are more likely than other type to result in poor outcomes due to delayed procedures (71%), increased complications from procedures (56%), and lengthier hospital stays (55%).
“As this year’s Ponemon report clearly shows, cyberattacks can have a direct impact on patient safety, and, in some cases, increase mortality rates,” Witt said. “As physicians still adhere to the Hippocratic Oath, and its core tenet of do no harm, it’s imperative that healthcare continues to focus on cybersecurity in support of healthcare’s mission and to protect patients.”
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Both recurrent and severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) portend worse outcomes in children, according to 2 new studies published in JAMA Network Open. A new device might improve pediatric AKI outcomes.
Infants in neonatal ICUs with recurrent AKI had a significantly longer hospital stay than those with a single episode of AKI, Austin D. Rutledge, DO, of the Medical University of South Carolina in Charleston, and colleagues reported. Their finding is from the AWAKEN study of 2162 infants, of whom 605 developed AKI, including 133 (22%) with recurrent AKI. Risk factors for recurrent AKI included younger gestational age, lower birthweight, and higher stage of initial AKI. Infants with recurrent AKI had a median length of stay of 60 days compared with 18 and 17 days for infants with a single AKI episode or no AKI, respectively.
“These results support the paradigm that [recurrent] AKI is likely an important and distinct clinical entity meriting increased surveillance after an initial AKI episode,” Dr Rutledge’s team wrote. “The present study provides important information that will inform the development of evidence-based post-AKI care guidelines to prevent and diagnose [recurrent] AKI sooner to improve outcomes.”
The second study found that use of continuous kidney replacement therapy (CKRT) for AKI or fluid overload in children, adolescents, and young adults in the intensive care unit often leads to major adverse kidney outcomes (MAKE). Among 969 patients aged 0 to 25 years treated with CKRT for AKI or fluid overload from the 2015 to 2021 Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry, 630 patients (65.0%) developed MAKE within 90 days, Dana Y. Fuhrman, DO, MS, of the University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh in Pennsylvania, and colleagues reported. MAKE-90 comprised death or persistent kidney dysfunction, including new dialysis dependence or a 25% decline in estimated glomerular filtration rate (eGFR) from baseline. Patients admitted for congenital heart disease or cardiomyopathy had the highest rates of MAKE-90. Of the full cohort, 38% died within 90 days.
Patients who were successfully weaned from CKRT within 28 days had significant 68% and 98% decreased odds of MAKE-90 in adjusted analyses compared with patients for whom attempts at removal from CKRT failed or for whom no attempt was made, respectively.
“Our study highlights the need for a shift in the paradigm of how we study CKRT in youths, from focusing on CKRT initiation to a more wholistic approach systematically evaluating liberation,” Dr Fuhrman’s team wrote.
In February 2024, the FDA granted a humanitarian device exemption approval to SeaStar Medical’s selective cytopheretic device for pediatric AKI due to sepsis or a septic condition requiring CKRT.3 The device selectively targets proinflammatory neutrophils and monocytes during CKRT to reduce hyperinflammation and cytokine storm. In a pooled analysis from the SCD-PED-01 and SCD-PED-02 studies, published in Kidney Medicine, 22 pediatric patients treated with the immunomodulatory extracorporeal device had a 77.3% survival rate to day 60 after discharge.4
In these studies, no device-related serious adverse events or device-related infections occurred and no dialysis dependency at day 60. A post-market registry study will be established to collect additional data regarding safety and efficacy.
To receive the therapy, patients must weigh at least 10 kg (approximately 22 pounds). Efforts are underway to create a device for children weighing less than 10 kg.
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