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Clinician Article

The impact of pharmacological and lifestyle interventions on body weight in people with type 1 diabetes: A systematic review and meta-analysis.



  • Tandon S
  • Ayis S
  • Hopkins D
  • Harding S
  • Stadler M
Diabetes Obes Metab. 2021 Feb;23(2):350-362. doi: 10.1111/dom.14221. Epub 2020 Nov 2. (Review)
PMID: 33026152
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Special Interest - Obesity -- Physician
    Relevance - 6/7
    Newsworthiness - 5/7
  • Endocrine
    Relevance - 4/7
    Newsworthiness - 4/7

Abstract

AIM: To systematically review the effects of pharmacological and lifestyle interventions on body weight as a secondary outcome in people with type 1 diabetes.

METHODS: The Ovid Medline, Embase and Cochrane Library databases were searched for relevant pharmacological (glucagon-like peptide-1 [GLP-1] receptor agonist, sodium-glucose co-transporter-2 [SGLT-2] inhibitor, dipeptidyl peptidase-4 [DPP-4] inhibitor and metformin) and lifestyle intervention studies (diet and exercise) for adults with type 1 diabetes reporting body weight change and HbA1c published from January 2000 to May 2020. Meta-analyses were performed for 16 randomized controlled trials (RCTs).

RESULTS: Thirty-three RCTs (n = 9344 participants), 26 pharmacological (on average 43.9 years, 83.1 kg, HbA1c 8.1%; 55.8% male) and seven lifestyle-based interventions (on average 37.0 years, 85.0 kg, HbA1c 8.1%; 84.6% male), were analysed. The GLP-1 receptor agonist liraglutide 0.6 mg (mean difference [MD]: -2.22 kg [95% CI: -2.55 to -1.90]), 1.2 mg (MD: -3.74 kg [95% CI: -4.16 to -3.33]) and 1.8 mg (MD: -4.85 kg [95% CI: -5.29 to -4.41]), and the SGLT-2 inhibitors empagliflozin 2.5 mg (MD: -1.47 kg [95% CI: -2.23 to -0.71]), 10 mg (MD: -2.77 kg [95% CI: -3.24 to -2.31]) and 25 mg (MD: -3.06 kg [95% CI: -3.57 to -2.55]) and sotagliflozin 200 mg (MD: -2.40 kg [95% CI: -2.87 to -1.94]) and 400 mg (MD: -3.23 [95% CI: -3.73 to -2.72]) were associated with significant reductions in body weight. No significant effect on body weight was found for DPP-4 inhibitors, other GLP-1-receptor agonists, metformin, or for lifestyle interventions (i.e. exercise and diet).

CONCLUSIONS: In people with type 1 diabetes, several adjuvant pharmacological interventions showed weight reduction as a secondary outcome. Future studies in overweight people with type 1 diabetes are needed to establish whether the lifestyle and pharmacological interventions reviewed here have potential as components of complex interventions aimed at body weight reduction as a primary outcome.


Clinical Comments

Endocrine

Most of the drugs reviewed are off-label in type 1 diabetes in a majority of countries because of safety concerns.

General Internal Medicine-Primary Care(US)

This is a meta analysis of 33 RCT of lifestyle or drug interventions in 9344 type 1 diabetics. It demonstrated that GLP1 and STLG 2 inhibitors lead to moderate weight loss while metformin and DDP 4 inhibitors do not. Furthermore various diet and exercise prescriptions did not lead to significant weight loss either.

Special Interest - Obesity -- Physician

The use of GLP-1 receptor agonist and SGLT-2 inhibitors among type 1 diabetes population may have an effect on reduction of their body weight.

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