Tight diabetes control sometimes comes with a price: your weight goes up and your blood glucose may go too low. But weight loss helps tremendously with management of type 2 diabetes. In our research, when obese adults with diabetes lose seven percent of their body weight (only 14 pounds if you weigh 200), insulin action improves by around 57 percent—more than you can get with most diabetes pills. In addition, weight loss helps lower your blood pressure, cholesterol levels, blood fats, and heart disease risk.
Given how many people now are overweight and have diabetes, we’ve had to rethink the way that we treat diabetes to minimize the negative effect of diabetes medications on body weight. Targeting weight loss and not just diabetes control will likely prove to be more effective and help lower the costs of managing diabetes.
In fact, we’ve already proved that this approach works! At the Joslin Diabetes Center in Boston, we implemented Why WAIT™. It’s a 12-week outpatient program for weight loss and intensive blood glucose control that focuses on using weight-friendly diabetes medications and reducing or eliminating ones that promote weight gain. We combined this approach with physical activities (like resistance training), balanced eating, stress management, and lasting behavior change. Our participants have lost an average of 23.8 pounds (almost 10 percent of their body weight) after only 12 weeks. What’s more, they’ve been able to keep off most of it (an average of 16.2 lbs) five years later, while most people on other diets gain all their weight back.
Want to take less medicine? Our participants have been able to reduce their doses and number of diabetes medications. Many types of insulin cause you to gain weight, but 21 percent of our participants treated with insulin were able to stop taking any by the program’s end. Those who still needed some cut their doses by over 50 percent, which made it a lot easier for them to avoid both weight regain and low blood glucose. Are fewer pills in your future? Participants in the Why WAIT™ Program cut their diabetes pills by 50 to 60 percent and many of them went off them altogether.
You can also save a lot of money. The average Why WAIT™ participant saved $140 on diabetes medications during the 12-week program, which equates to saving $561 in a year—and your total health care savings is likely to be closer to $1,600 per year.
Boston may be out of your budget to visit for 12 weeks, so how can you achieve this wherever you live? The Diabetes Breakthrough, based on Why WAIT™, is a new book that will give you all of the information you need to work the plan from home.
Now that you understand that the prescribed medications you take may be sabotaging your efforts to lose weight, it’s time to talk to your doctor or health care team about how to change your medications to optimize your weight loss.
What to keep in mind when talking with your doctor that diabetes medications are either “weight friendly” (meaning they don’t affect your weight or cause weight loss) or “weight fury” (they cause weight gain).
Weight Friendly Diabetes Medications
- Metformin doesn’t raise or lower your body weight, but can help keep your morning blood glucose levels in check.
- DPP-4 inhibitors are newer diabetes medications that also don’t affect weight, such as Januvia, Galvus, Onglyza, Tradjenta, and Nisena.
- SLGT-2 inhibitors are the newest oral diabetes medication and are known to cause weight loss. Examples of SGLT2 inhibitors are Invokana and Forxiga, with many more being created.
- Byetta, Victoza, Bydureon, and Symlin are the only injectable diabetes medications that cause you to lose weight and can be used with Metformin for maximum weight loss in people with type 2 diabetes. Symlin can be also used for type 1 patients who are overweight or obese.
Weight Fury Diabetes Medications
- Medications like Glucotrol and DiaBeta generally cause weight gain. If you must take them, using the extended-release ones (like Glucotrol XL or Amaryl) will help.
- Although Actos and Avandia increase your insulin action, they generally cause significant weight gain.
- Insulin use in general causes weight gain. Among basal insulins, Levemir causes less weight gain than NPH or Lantus. If you take short-acting insulin with meals, discuss with your doctor the possibility of injecting it immediately after eating or within 20 min from the start of your meal—which allows you to dose based on what you actually eat and not what you planned to eat. Apidra works best because it takes effect quicker.
In conclusion, our program shows that losing weight is the key to controlling diabetes and reducing the number and doses of diabetes medications that you need to take. Together with a healthier lifestyle, this approach will help you control your diabetes while you lose all the weight you want to—and keep it off for life!
Dr. Osama Hamdy is medical director of the obesity clinical program at Joslin Diabetes Center. Dr. Sheri Colberg is professor of exercise science at Old Dominion University. They are the authors of The Diabetes Breakthrough (Harlequin, 2014). For more information, visit www.TheDiabetesBreakthrough.com.