Pharmacotherapy for obesity in individuals with type 2 diabetes

ABSTRACT

Introduction: Type 2 diabetes (T2DM) is associated with significant morbidity and mortality. Obesity is one of the main risk factors for T2DM and its management requires a multidisciplinary approach, which may include pharmacotherapy.

Areas covered: In this paper, data on efficacy, tolerability and safety of FDA-approved pharmacotherapies for obesity (orlistat, phentermine/topiramate extended-release, lorcaserin, bupropion sustained release/naltrexone sustained release and liraglutide) are reviewed, focusing on individuals with type 2 diabetes.

Expert opinion: Obesity is the major pathophysiologic driver of T2DM; conversely 5–10% weight loss leads to significant improvement in glycemic control, lipids and blood pressure. Weight loss maintenance is difficult with lifestyle interventions alone and may require adjunctive therapies. There is good evidence for the efficacy and tolerability of approved anti-obesity pharmacotherapies in individuals with T2DM, with current cardiovascular safety data being most favorable for liraglutide, orlistat and lorcaserin. Given the link between obesity and T2DM, a weight-centric therapeutic approach including use of weight reducing anti-diabetic therapies, and anti-obesity pharmacotherapies is both intuitive and rational to improve glycemic and other metabolic outcomes in patients with T2DM.

KEYWORDS:

• Obesity
• type 2 diabetes
• weight loss
• pharmacotherapy

Declaration of Interest

L J Aronne reports receiving consulting fees from and/ serving on advisory boards for ERX Pharmaceuticals, Jamieson Laboratories, Pfizer, Novo Nordisk, Sanofi, Eisai, Janssen, UnitedHealth Group Ventures, and Gelesis, receiving research funding from Aspire Bariatrics, Eisai, AstraZeneca and Novo Nordisk, having an equity interest in BMIQ, ERX Pharmaceuticals, Zafgen, Gelesis, MYOS, and Jamieson Laboratories, and serving on a board of directors for MYOS, BMIQ and Jamieson Laboratories. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Article Highlights

• Obesity is the major pathophysiologic driver of T2DM and its management requires a multidisciplinary approach which may include pharmacotherapy.

• There are currently five FDA-approved pharmacotherapies to treat obesity including orlistat, phentermine/topiramate ER, lorcaserin, bupropion SR/naltrexone SR and liraglutide.

• There is good evidence for the efficacy and tolerability of approved pharmacotherapies in individuals with T2DM.

• Current cardiovascular safety data is most favorable for liraglutide, orlistat and lorcaserin.

• A weight-centric therapeutic approach including use of weight reducing anti-diabetic and anti-obesity pharmacotherapies improves glycemic and other metabolic outcomes in individuals with T2DM.

Additional information

Funding

This manuscript has not been funded.