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7. Obesity Management for the Treatment of Type 2 Diabetes

  1. American Diabetes Association
Diabetes Care 2017 Jan; 40(Supplement 1): S57-S63. https://doi.org/10.2337/dc17-S010
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Article Figures & Tables

Tables

  • Table 7.1

    Treatment for overweight and obesity in type 2 diabetes

    BMI category (kg/m2)
    Treatment23.0* or 25.0–26.927.0–29.927.5* or 30.0–34.935.0–39.9≥40
    Diet, physical activity, and behavioral therapy┼┼┼┼┼
    Pharmacotherapy┼┼┼┼
    Metabolic surgery┼┼┼
    • ↵* Cutoff points for Asian American individuals.

    • ↵┼ Treatment may be indicated for selected motivated patients.

  • Table 7.2

    Medications approved by the FDA for the long-term (more than a few weeks) treatment of obesity

    1-Year weight change status2–5Adverse effects2,6–12
    Generic drug name (proprietary name[s]) and dosage strength and formAdult dosing frequencyAverage wholesale price (per month)1Average weight loss relative to placebo% Patients with ≥5% loss of baseline weightCommon7Serious7
    Lipase inhibitor
    Orlistat (Alli) 60 mg caps or orlistat (Xenical) 120 mg caps60 mg or 120 mg t.i.d. (during or up to 1 h after a low-fat meal)$43–86 (60 mg);
    $670 (120 mg)
    2.5 kg (60 mg);
    3.4 kg (120 mg)
    35–73%Abdominal pain/discomfort, oily spotting/stool, fecal urgency, flatulence, malabsorption of fat-soluble vitamins (A, D, E, K) and medications (e.g., cyclosporine, thyroid hormone replacement, or anticonvulsants), potentiation of the effects of warfarinLiver failure and oxalate nephropathy
    Selective serotonin (5-HT) 5-HT2C receptor agonist
    Lorcaserin (Belviq) 10 mg tabs10 mg b.i.d.$2633.2 kg38–48%Hypoglycemia, headache, fatigueSerotonin syndrome or NMS-like reactions, suicidal ideation, heart valve disorder (<2.4%), bradycardia
    Sympathomimetic amine anorectic/antiepileptic combination
    Phentermine/topiramate ER (Qsymia) 3.75 mg/23 mg caps, 7.5 mg/46 mg caps, 11.25 mg/69 mg caps, 15 mg/92 mg capsRecommended dose: 3.75 mg/23 mg q.d. for 14 days, then increase to 7.5 mg/46 mg q.d. Maximum dose: 15 mg/92 mg q.d.$239 (maximum dose using the highest strength)6.7 kg (7.5 mg/46 mg);8.9 kg (15 mg/92 mg)45–70%Paresthesia, xerostomia, constipation, headacheTopiramate is teratogenic and has been associated with cleft lip/palate
    Opioid antagonist/aminoketone antidepressant combination
    Naltrexone/bupropion (Contrave) 8 mg/90 mg tabsMaximum dose: two tablets of Contrave b.i.d. for a total daily dosage of naltrexone 32 mg/bupropion 360 mg$251 (maximum dose)2.0–4.1 kg (32 mg/360 mg)36–57%Nausea, constipation, headache, vomitingDepression, precipitation of mania, contraindicated in patients with a seizure disorder
    Acylated human glucagon-like peptide 1 receptor agonist
    Liraglutide (Saxenda) 6 mg/mL prefilled penMaintenance dose: 3 mg s.c. q.d.$1,3855.8–5.9 kg51–73%Hypoglycemia, nausea, vomiting, diarrhea, constipation, headachePancreatitis, thyroid C-cell tumors in rodents, contraindicated in patients with personal/family history of MTC or MEN2, acute renal failure
    • All medications are contraindicated in women who are or may become pregnant. Women in their reproductive years must be cautioned to use a reliable method of contraception. Caps, capsules; ER, extended release; MEN2, multiple endocrine neoplasia type 2; MTC, medullary thyroid carcinoma; NMS, neuroleptic malignant syndrome; s.c., subcutaneous; tabs, tablets.

    • ↵1 RED BOOK Online. Micromedex 2.0 (electronic version). Truven Health Analytics, Greenwood Village, CO.

    • ↵2 Physicians' Desk Reference. PDR Network, LLC (electronic version). Truven Health Analytics, Greenwood Village, CO.

    • 3 Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311:74–86.

    • 4 Astrup A, Carraro R, Finer N, et al.; NN8022–1807 Investigators. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. Int J Obes (Lond) 2012;36:843–854.

    • ↵5 Wadden TA, Hollander P, Klein S, et al.; NN8022–1923 Investigators. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond) 2013;37:1443–1451.

    • ↵6 DrugPoints System (electronic version). Truven Health Analytics, Greenwood Village, CO.

    • ↵7 Selective common (defined as an incidence of >5%) and serious adverse effects are noted. Refer to the medication package inserts for full information about adverse effects, cautions, and contraindications.

    • 8 Data of common adverse effects for Xenical were derived from seven double-blind, placebo-controlled clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes), but the percentage of patients with type 2 diabetes was not reported. In clinical trials in obese patients with diabetes, hypoglycemia and abdominal distension were also observed.

    • 9 Data of common adverse effects for Belviq were derived from placebo-controlled clinical trials in patients with type 2 diabetes.

    • 10 Data of common adverse effects for Qsymia were derived from four clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes); 13% had type 2 diabetes.

    • 11 Data of common adverse effects for Contrave were derived from five double-blind, placebo-controlled clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes); 13% had type 2 diabetes.

    • ↵12 Data of common adverse effects for Saxenda were derived from clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes). Percentage of patients with type 2 diabetes was not reported.

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7. Obesity Management for the Treatment of Type 2 Diabetes
American Diabetes Association
Diabetes Care Jan 2017, 40 (Supplement 1) S57-S63; DOI: 10.2337/dc17-S010

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  • 7. Diabetes Technology: Standards of Medical Care in Diabetes—2020
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