Diabetes Medications Associated with Weight Gain Versus Drug Free Care
Type 2 Diabetes Medications Associated with Weight Gain Versus Drug Free Care
Blog 5
Can My Medications Be Making Me Gain Weight?
Unfortunately, many drug therapies for diabetes are associated with further weight gain as sugar (glucose) metabolism changes (470–472).
Insulin is a weight gain hormone. Besides insulin, other prominent families of drugs for type 2 diabetes work by increasing insulin production or increasing insulin’s effectiveness in the body. These medications generally cause weight gain.
People with type 2 diabetes and high blood pressure often have high cholesterol as well. Fish oil has been found to be 10% more effective in preventing death than the Statin (atorvastatin or Lipitor) family of cholesterol lowering drugs. Meta-analysis, Studer et al, Archives of Internal Medicine 2005 (805)
If you have diabetes always consult with your physician before changing your diet, exercise, or medications. If you take medication for diabetes, do not attempt to start the nutrition programs described in the blogs on type 2 diabetes, unless your doctor reduces, adjusts, or discontinues your diabetes medications before your nutrition is changed. The reason for this is because drugs and nutrition must be carefully prescribed together by your doctor to prevent the dangers of low blood sugars (hypoglycemia). Nutrition and drug therapies are highly interconnected.
People who have type 2 diabetes may also have high blood pressure, and issues with high cholesterol. Medications for these conditions may also be associated with weight gain and will be discussed in this series of blogs on type 2 diabetes.
1 in 4 adults in the US over age 45 takes a statin drug for cholesterol control or heart protection. Statin drugs are associated with weight gain.
Sugiyama T et al JAMA 2014 (60) and Consumer Reports (574)
40 million Americans take statin drugs to lower cholesterol.
Lipitor (atorvastatin), a statin drug, was the #1 selling drug in the world.
Many of the common drug families used to treat diabetes, that work best to lower blood sugars and glycated hemoglobin (also known as hemoglobin A1c, HbA1c, A1C, Hb1c, HGBA1C or sugar coated hemoglobin), such as sulfonylureas, meglitinides, thiazolidinediones, and insulin, are known to be associated with weight gain (130, 131, 473).
People with type 2 diabetes are usually already overweight or obese. (129)
The exception drug is metformin, which is usually associated with mild weight loss or weight neutrality. But many diabetics have kidney issues, so they cannot take metformin.
Glucophage (metformin)
Two of newer drugs (DPP4-Inhibitors) originally not thought to cause weight gain, have been found to be associated with weight gain in large meta-analysis studies. Most of these medications also carry FDA warnings for potentially causing heart failure and severe joint pain.
One family called SGLT2 Inhibitors of new drugs that is associated with mild initial weight loss also reduced risk of heart disease deaths and all cause mortality. (2160) Concerns with this family include it does not lower HbA1c very much, and warnings for increased risk of ketoacidosis (difficulty breathing, vomiting, abdominal pain, confusion, sleepiness); increased risks of serious UTI (urinary tract infections), requiring hospitalization; risk of severe infection of the perineum and genital area (Fournier gangrene) requiring surgery and advanced antibiotic therapy; and increased risk of bone fractures. This family is and includes drugs like:
The injectable GLP-1 receptor agonist drugs are generally associated with mild weight loss, but they are not safe for people who have a tendency for pancreatitis.
The first oral drug in this family is Rybelsus (semaglutide). Rybelsus may make it easier to prescribe oral combination therapy for diabetes that may not lead to weight gain. In 2022 The FDA approved Mounjaro (tirzepatide)injection that acts on both GLP-1 and GIP (glucose dependent insulinotropic polypeptide).
Frequently people with type 2 diabetes take drugs associated with weight gain. But much can be done to avoid the weight gain and restore health.
“Our findings suggest that even if you have had type 2 diabetes for 6 years, putting the disease into remission is feasible.” (1253)
Medical literature still supports nutrition and exercise as more effective than medications to treat type 2 diabetes.
We introduce nutrition approaches for metabolic syndrome here and flesh them out more at the end of the blogs on diabetes, but our companion book BATON Diet provides comprehensive nutrition support in laymen’s terms.
Forty-nine (49) primary care clinics in Scotland and England find 50% cure rate for type 2 diabetes via nutrition. Lean, Michael EJ et al, Lancet 2017 (1253).
Liquid diet, plus gradual reintroduction of food, prompts type 2 diabetes remission. Lean, Michael EJ et al, The DiRECT trial; The Lancet 2017 (1253) Type 2 diabetes is typically thought to be a chronic disease that requires lifelong treatment. This study published in 2017 in Lancet found that in everyday clinic practice type 2 diabetes, even if diabetes had been treated with drugs for up to 6 years, was put into remission in almost half the people resulting in drug free care. The prospective study took place in 49 clinics in Scotland and England. The research compared nutrition versus standard best practice diabetes care according to guidelines in 49 primary-care practices in the United Kingdom. The study was done with people ages 20 to 65 diagnosed with type 2 diabetes who had a body mass index (BMI) of 25 to 45kg/m2, and who were not taking insulin. The study used a liquid diet, followed by stepped reintroduction of foods. The DiRECT trial (Diabetes Remission Clinical Trial); Lean, Michael EJ et al, The Lancet 2017 (1253)
Medications for diabetes and blood pressure were stopped. The liquid nutrition program was used instead for half of the participants (149 people). Later foods were reintroduced slowly. Remission of type 2 diabetes occurred in about half of people who participated in the nutrition program.
After 12 months the authors reported that 46% of people that had been treated with the liquid diet achieved remission of type 2 diabetes. Only 4% of people treated in the control group achieved remission.
Drug Free Care
People treated with the liquid diet were 19.7X (19.7 times) more likely to achieve remission. (Odds ratio 19.7 p<0.0001) The authors defined remission as drug free care resulting in consistent normal lab results of HbA1C of less than 6.5% (<48 mmol/mol) from 2 months after being off of diabetes medications to 12 months.
The study discovered that dietitians or nurses, given an 8 hour training class, could manage people with type 2 diabetes using a liquid diet in place of drug therapy. The liquid diet was the Cambridge Weight Plan (825–853 kcal/day formula diet for 3–5 months).
Next came stepped food reintroduction (2–8 weeks), and structured support for long-term weight loss maintenance. No increase in exercise was required in the weight loss program during the early parts of the program. Later, during the long-term follow up, increased daily physical activity was incorporated.
After 12 months, 24% of the people who had participated in the liquid nutrition program had lost 15kg (33 pounds) weight and kept it off at 12 months and no participants in the control group lost 15 kg (33 pounds) (p<0.0001).
The more weight participants lost the better their remission rate was. None of the people who gained weight in the program achieved remission. People who lost the most weight had the highest remission rates. No serious adverse events led to any people quitting participation the study. (1253) After 12 months, almost half of patients were in remission of type 2 diabetes and off of drug therapy for diabetes. Lean, Michael EJ et al, The DiRECT trial; The Lancet 2017 (1253)
“Our findings show that, at 12 months, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. Remission of type 2 diabetes is a practical target for primary care.” The “DiRECT” trial; Lean, Michael EJ et al, The Lancet 2017 (1253)
Quality of life
Quality of life, as measured by the EuroQol 5 Dimensions visual analogue scale, improved by 7.2 points in the intervention (liquid diet) group, and decreased by 2.9 points in the control (standard best practice for diabetes care) treatment group. Lean, Michael EJ et al, The Lancet 2017 (1253) “The big challenge is long-term avoidance of weight regain. Follow-up of DiRECT will continue for 4 years and reveal whether weight loss and remission are achievable in the long term.” (Quote from Prof Taylor at International Diabetes Federation (IDF) Congress 2017) Other completed long-term studies have shown extended and enduring remission and benefit from lifestyle changes. (1258, 1259)
“Remission of type 2 diabetes: mission not impossible” Uusitupa, M, The Lancet 2017 (1256)
Type 2 diabetes is a disease that is increasing rapidly worldwide. The root causes are linked to weight gain and obesity, lack of exercise, and unhealthy nutrition pattern—all of which are modifiable. (1257) Well controlled lifestyle interventions in people with impaired sugar tolerance can prevent or postpone the development of type 2 diabetes through weight loss, physical activity, and healthy food choices. (1258, 1259)
“In view of the results of the DiRECT trial, a nonpharmacological approach should be revived,” Prof Uusitupa, The Lancet 2017 (1256)
“Moreover, diabetes risk is decreased for many years after the active intervention period, suggesting a legacy effect.” Uusitupa, M, The Lancet 2017 (1256)
Mediterranean diet yielded 50% cure for metabolic syndrome (1477)
Metabolic syndrome can lead to developing prediabetes or diabetes. Two years of Mediterranean style diet in patients with the metabolic syndrome resulted in 50% of patients no longer having metabolic syndrome. (1477)
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