37
Obesity and Diabetes
Medication Management of Type 2 Diabetes
➤ Prioritize the use of glucose-lowering medications with proven
weight-loss benefits.
➤ The most effective medications for managing diabetes
and obesity are the dual glucose-dependent insulinotropic
polypeptide (GIP) and GLP-1 receptor agonist tirzepatide, as well
as the subcutaneous GLP-1 RA semaglutide.
➤ Other subcutaneous GLP-1 RAs are effective in controlling
blood glucose levels and assisting with weight loss, but are less
effective than tirzepatide and semaglutide.
➤ SGLT2 inhibitors and metformin can also induce modest weight
loss.
➤ For individuals treated with SGLT2 inhibitors, ketogenic diets may
increase the risk of ketoacidosis.
➤ Medications that predispose to hypoglycemia should be titrated
downward or discontinued with weight loss.
➤ Consider referral to adult endocrinology if diabetes is not well
controlled despite titration of medications.
➤ Consider referral to pediatric endocrinology for the treatment of
type 2 diabetes in children.
Role and Benefits of Metabolic and Bariatric Surgery
➤ Consider metabolic and bariatric surgery for people with diabetes
mellitus and obesity (BMI >30 kg/m² or ≥27 kg/m² in Asian
individuals).
➤ Benefits include significant long-term weight loss, superior
glycemic control, reduced cardiovascular disease, lower all-cause
mortality, and improved quality of life.
Diabetes Remission
➤ Defined as hemoglobin A1c <6.5% maintained for at least three
months following discontinuation of all glucose-lowering
medications.
➤ Diabetes remission following bariatric surgery has been reported
as 38% at 3 years and 13% at 12 years.
