ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

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Original Article
Is this the end of intensified insulin therapy and obesity in light of updates with novel medicines?
Abstract
Aims: Modern times witness an increased prevalence of obesity and diabetes mellitus. While patients are offered a plan for blood glucose regulation, possible obesity issues, unfortunately, remain ignored. Blood glucose regulation inevitably deteriorates over time in diabetic patients that gradually gain weight.
Methods: We recruited 42 diabetic patients who applied to our internal medicine outpatient clinic to investigate the impacts of two new generation therapies, sodium-glucose co-transporter-2 inhibitor (SGLT-2i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), on weight. Six patients were excluded from follow-up for various reasons, and the study was finalized with 36 patients. The patients were followed up regarding body mass index (BMI), HbA1c levels, and insulin cessation or dose reduction.
Results: We stopped insulin in 20 of 36 patients who started to receive SGLT-2i and GLP1-RA, while the insulin dose was reduced in the remaining patients. While the mean basal HbA1c level of the first group with insulin cessation was 9.13% (min-max: 6.4-14), it was recorded as 7.63% (min-max: 5, 2-10,8) in the sixth month of treatment modification (p< 0.001). Despite a slight HbA1c increase in two patients, we concluded a significant decrease in HbA1c levelsin 18 patients. Altogether, these 20 patients experienced an average of 1.5% HbA1c reduction. The findings also revealed that the mean basal BMI value (38.99 kg/m2; min-max: 33.2-43.4) among these 20 patients significantly decreased to 38.13 kg/m2 (0.86 kg/m2) in the sixth month of treatment modification. Among eight patients with reduced insulin and HbA1c level, the mean BMI value changed from 43.05 kg/m2 (min-max: 38.3-52.5) to 40.91 (min-max: 38.1-50) at the sixth-month follow-up. In this case, we may assert that losing weight has a positive impact on blood glucose regulation. However, it changed from 34.87 kg/m2 (min-max: 30.6-38.2) to 35.77 kg/m2 (min-max: 31. 8-39.1) among the other eight patients with reduced insulin but unreduced HbA1c.
Conclusion: Overall, we believe that SGLT-2i and GLP1-RA, with significant benefits in both cardiovascular protection and weight control, would be more advantageous when used more frequently in obese patients without obvious contraindications since they rarely cause hypoglycemia and are easily tolerated.

Keywords : Type 2 diabetes mellitus, novel therapies, sodium glucose co-transporter-2 inhibitors, glucagon-like peptide-1 agonists

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1. American Diabetes Association. Diagnosis and classification ofdiabetes mellitus. Diabetes care 2005; 28: 5-10.
2. International Diabetes Federation. Available online: https://idf.org/. 2022
3. Picke AK, Campbell G, Napoli N, Hofbauer LC, Rauner M.Update on the impact of type 2 diabetes mellitus on bonemetabolism and material properties. Endocrine Connections2019; 8: R55-R70.
4. Goyal R, Jialal I. Diabetes mellitus type 2. Europe PMC 2018.
5. Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linkingdiabetes mellitus and obesity. Diabetes Metab Syndr Obes 2014;7: 587-91.
6. Boden G. Fatty acids and insulin resistance. Diabetes Care 1996;19: 394-95.
7. Care D. Standards of medical care in diabetes 2019. DiabetesCare 2019; 42: 124-38.
8. American Diabetes Association Professional PracticeCommittee; 8. Obesity and Weight Management for thePrevention and Treatment of Type 2 Diabetes: Standards ofMedical Care in Diabetes&mdash;2022. Diabetes Care 2022; 45: 113-24.
9. Brown E, Wilding JP, Barber TM, Alam U, CuthbertsonDJ. Weight loss variability with SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes mellitus and obesity:mechanistic possibilities. Obesity Reviews 2019; 20: 816-28.
10. Uneda K, Kawai Y, Yamada T, et al. Systematic review andmeta-analysis for prevention of cardiovascular complicationsusing GLP-1 receptor agonists and SGLT-2 inhibitors in obesediabetic patients. Scientific Reports 2021; 11: 1-9.
11. Brown E, Wilding JP, Barber TM, Alam U, CuthbertsonDJ. Weight loss variability with SGLT2 inhibitors and GLP-1 receptor agonists in type 2 diabetes mellitus and obesity:Mechanistic possibilities. Obesity Reviews 2019; 20: 816-28.
12. Baggio LL, Drucker DJ. Glucagon-like peptide-1 receptor co-agonists for treating metabolic disease. Molecular Metabolism2021; 46: 101090.
13. Drucker DJ. GLP-1 physiology informs the pharmacotherapy ofobesity. Molecular Metabolism 2021: 101351.
14. DeFronzo RA. Combination therapy with GLP-1 receptoragonist and SGLT2 inhibitor. Diabetes Obes Metab 2017; 19:1353-62.
15. Li C, Luo J, Jiang M, Wang K. The efficacy and safety of thecombination therapy with GLP-1 receptor agonists and SGLT-2 inhibitors in type 2 diabetes mellitus: a systematic review andmeta-analysis. Frontiers in Pharmacology 2022: 13.
16. G&uuml;m&uuml;şsoy M, Bahşi R, S&uuml;rmeli DM, Turgut T, &Ouml;ztorun HS veark. Yaşlılarda hatalı ins&uuml;lin kullanımı ve ins&uuml;lin eğitimininetkisi. Van Tıp Derg 2018; 25: 323-31.
17. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutideand cardiovascular outcomes in type 2 diabetes. N Engl J Med2016; 375: 311-22.
18. Kahkoska AR, Abrahamsen TJ, Alexander GC, et al. Associationbetween glucagon-like peptide 1 receptor agonist and sodium-glucose cotransporter 2 ınhibitor use and COVID-19 outcomes.Diabetes Care 2021; 44: 1564-72.
19. Suhrie EM, Hanlon JT, Jaffe EJ, Sevick MA, Ruby CM,Aspinall SL. Impact of a geriatric nursing home palliative careservice on unnecessary medication prescribing. Am J GeriatricPharmacother 2009; 7: 20-5.
20. Brown E., Heerspink HJ, Cuthbertson DJ, Wilding JPSGLT2inhibitors and GLP-1 receptor agonists: established and emergingindications. Lancet 2021; 398: 262-76.
21. Genuth S. Insulin use in NIDDM. Diabetes care 1990; 13: 1240-64.
22. Meier JJ. GLP-1 receptor agonists for individualized treatment oftype 2 diabetes mellitus. Nat Rev Endocrinol 2012; 8: 728-42.
Article available in :
Volume 1, Issue 3, 2022
Page : 79-84
https://doi.org/10.51271/JTPM-0022
Article Information
Received : 16 Eki 2022
Accepted : 18 Kas 2022
Published : 26 Ara 2022
Corresponding Author :

Hakan Varol: Department of Internal Medicine, Faculty of Medicine, Kırıkkale University, Kırıkkale, TURKEY

[email protected]
Citation : Varol H, İğdeli U, Karahan İ, Çifci A. Is this the end of intensified insulin therapy and obesity in light of updates with novel medicines?. J Transl Pract Med. 2022;1(3): 79-84.

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