Medical Weight Loss
There's a class of type 2 diabetes medications that not only improves blood sugar control but may also lead to weight loss. This class of drugs is commonly called glucagon-like peptide 1 (GLP-1) agonists.
Weight loss can vary depending on which GLP-1 drug you use and your dose. Studies have found that all GLP-1 drugs can lead to weight loss of about 10.5 to 15.8 pounds (4.8 to 7.2 kilograms, or kg) when using liraglutide. Studies found people using semaglutide and making lifestyle changes lost about 33.7 pounds (15.3 kilograms) versus 5.7 pounds (2.6 kilograms) in those who didn't use the drug.
Diabetes drugs in the GLP-1 agonists class are generally taken by a shot (injection) given daily or weekly and include:
- Mounjaro (tirzepatide)
- Semaglutide (Ozempic) (weekly)
- Liraglutide (Victoza, Saxenda) (daily)
- Lixisenatide (Adlyxin) (daily)
- Semaglutide (Rybelsus) (taken by mouth once daily)
These drugs mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels.
Lower blood sugar levels are helpful for controlling type 2 diabetes. But it's not clear how the GLP-1 drugs lead to weight loss. Doctors do know that GLP-1s appear to help curb hunger. These drugs also slow the movement of food from the stomach into the small intestine. As a result, you may feel full faster and longer, so you eat less.
Along with helping to control blood sugar and boost weight loss, GLP-1s and SGLT-2 inhibitors seem to have other major benefits. Research has found that some drugs in these groups may lower the risk of heart disease, such as heart failure, stroke, and kidney disease. People taking these drugs have seen their blood pressure and cholesterol levels improve. But it's not clear whether these benefits are from the drug or weight loss.
The downside to GLP-1 drugs is that all but one has to be taken by a shot. And, like any drug, there is a risk of side effects, some serious. More common side effects often improve as you continue to take the drug for a while.
Some of the more common side effects include:
- Nausea
- Vomiting
- Diarrhea
Low blood sugar levels (hypoglycemia) are a more serious risk linked to the GLP-1 class of drugs. But the risk of low blood sugar levels often only goes up if you're also taking another drug known to lower blood sugar at the same time, such as sulfonylureas or insulin.
The GLP-1 class of drugs isn't recommended if you have a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia. Lab studies have linked these drugs with thyroid tumors in rats. But until more long-term studies are done, the risk to humans isn't known. They're also not recommended if you've had pancreatitis.
The drugs already discussed are indicated in people living with type 2 diabetes. There is also a drug that has a higher dose of liraglutide (Saxenda) that's approved for the treatment of obesity in people who don't have diabetes.
If you have diabetes and wonder if one of these drugs may be helpful for you, talk to your diabetes doctor or health care provider.
How They Work
Glucagon-like peptide (GLP-1) is a type of hormone known as an incretin that's lower than normal in type 2 diabetes. GLP-1 receptor agonists belong to a class of medications known as incretin mimetics.
By mimicking the effects of GLP-1, the GLP-1 receptor agonists have many effects.
Some of their actions include:
- Help control appetite and blood sugar levels
- Help the pancreas release the optimal amount of insulin, which transports glucose (sugar) to tissues in the body where it can be used for energy2
- Slow the rate at which food leaves the stomach, which helps to control post-prandial (after-meal) blood sugar levels
GLP-1 agonists work on different organs throughout the body.
GLP-1 sends a signal to the hypothalamus, the part of the brain responsible for appetite and thirst, to take in less water and food. This can lead to weight loss.
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Richard Lorenzo, D.O.
Kortney Jones ARNP