Background

There is limited real-world data on long-term weight loss maintenance in medically managed patients with obesity and type 2 diabetes (T2DM).

Methods

A retrospective chart review of patients who established care at an academic weight management center between 4/2014-4/2016 was performed. Demographics, medications, HbA1c, and weight changes after pharmacotherapy initiation were recorded over a 2-year follow-up period.

Results

Of 1775 new patients, 421 fulfilled eligibility criteria and 67 (15.9%) had T2DM. The average age was 62.5 ± 11.1 yrs and 55.2% were female. Mean baseline weight and BMI were 102.0 ± 26.3kg and 36.0 ± 7.8 kg/m2, respectively, and initial HbA1c was 7.5 ± 1.6%. Mean weight loss at yr-1 and yr-2 was similar (-8.1 ± 8.2% vs. -8.4 ± 8.9%, p= 0.68). The mean change in HbA1c from baseline to yr-1 and yr-2 was similar (-0.73% vs. -0.65%, p=0.51). There was no significant difference in weight loss between the T2DM and non-DM cohorts at 2 years (-8.4% vs. -10.3%, p=0.13). Sixty-five percent of patients achieved ≥5% weight loss at 1 year, and of these, 89% maintained that loss at 2 years. Thirty-seven percent of patients achieved ≥10% weight loss at 1 year, of which 64% maintained that loss at 2 years. Management strategies included minimizing the usage of weight-gain promoting medications such as insulin, sulfonylureas, and thiazolidinediones, meglitinides, and optimizing weight-losing medications such as metformin, GLP-1 Rc agonists, and SGLT-2 inhibitors. At 2 years, 80.6% of patients were on metformin, 55.2% on SGLT-2 inhibitors and 46.3% on GLP-1 Rc agonists. Additionally, by 2 years, 29 (43.3%) patients were on anti-obesity medications (AOM) that were either on/off label; the most commonly used medications were bupropion (20.9%), topiramate (17.9%), lorcaserin (10.4%) and phentermine (10.4%).

Conclusions

Maintenance of clinically significant weight loss and improvement in HbA1c is achievable in the real-world setting with AOMs and a weight-centric approach to treatment of T2DM.