GLP-1 in Type 2 diabetes: Making weight loss possible


Dr. Norman N. Chan, M.D. 

Specialist in Endocrinology, Diabetes and Metabolism

Diabetes increases the risk of complications such as coronary heart disease, stroke and kidney failure. Effective treatment with drug therapies in conjunction with lifestyle modification may reduce this risk. However, different classes of anti-diabetic drugs have different effect on body weight. The new class of GLP-1 agonist controls after-meal glucose effectively and promotes weight loss.

 

Type 2 Diabetes mellitus is highly prevalent in Hong Kong, affecting about 10% to 12% of adults. Poor control diabetes may lead to complications such as coronary heart disease, stroke, kidney dialysis and leg amputation. Central obesity is a major cause of diabetes and weight control is fundamental in its management. However, several classes of anti-diabetic medication can lead to an increase in weight. Choosing the right combination of drugs is important in controlling diabetes while not aggravating weight problem.

 

Dr. Norman N. Chan, Specialist in Endocrinology, Diabetes and Metabolism said proper management of diabetes is

crucially important. “Sustained high blood glucose increases the risk of fatal complications like coronary heart disease.

Furthermore, diabetes may lead to other complications such as stroke, kidney failure, blindness, nerve damage in feet, erection problems in men and many others.”

 

“Management of diabetes is generally about keeping blood glucose levels to a target HbA1c level of 6.5 %, while elderly may have a lower target of 7.0 % to avoid over-treatment. The goal can be achieved by changing lifestyle and a right combination of medications. Patients can modify their lifestyle in various ways, including having healthy diet habits, by eating little and controlling the amounts of carbohydrate and sugar consumed, exercising 30 minutes a

day, and consulting doctor regularly to check if there is any complication, and to monitor their HbA1c levels.”

 

Dr. Chan explained that there are several classes of anti-diabetic drugs and also insulin. “Different classes of anti-diabetic medications have different impact on body weight; the latest GLP-1 agonist plays an important role, especially for those who are diagnosed as in the initial stage of diabetes. This type of medication effectively controls

blood glucose level while having positive influence on weight. Unlike insulin, it reduces the risk of hypoglycemia (very low blood sugar).”

 

“GLP-1 is a gut hormone released from our body to stimulate insulin release from the pancreatic beta-cells and inhibits glucagon release to lower blood glucose level. The medication suppresses satiety center in the brain, reducing the patient’s desire for food. It also slows down stomach emptying, and lowers after-meal glucose peak. As a result, patients taking this medication will lose weight. In addition, GLP-1 agonist would reduce the risk of hypoglycemia.”

 

There are two GLP-1 agonists available in Hong Kong, exenatide and liraglutide. Exenetide requires two injections per day but the new GLP-1 agonist liraglutide requires only one injection per day, which is convenient and easy to use. Dr. Chan said the medication is very different from insulin, which may cause weight gain. He illustrated this with a recent case example.

 

“There is an Australian patient, who is in her early 50s and has been diagnosed with Type 2 diabetes for many years, had HbA1c level and health condition improved after being treated with the once daily GLP-1 agonist. Previously she was treated with two insulin injections a day and metformin, and had a BMI of 35 as insulin makes her feel hungry frequently. But four weeks after adding the once daily GLP-1 agonist to her existing treatment, she has a 3-kg weight reduction, better level of blood glucose, and she was able to reduce insulin as well. I believe her HbA1c levels will keep improving,” remarked Dr. Chan.