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GLP-1 agonists provide modest weight loss in routine clinical care

With GLP-1 agonists providing impressive weight losses in trials how well to the drugs perform in a real-world clinical setting

A retrospective analysis of glucagon-like peptide-1 (GLP-1) agonists use in overweight patients with type 2 diabetes has found that in routine clinical practice, the drugs give rise to a modest degree of weight loss.

It has long been recognised that obesity is an independent risk factor for cardiovascular disease. In addition, cardiovascular disease is often present in those with type 2 diabetes and presents a major cause of death among such patients.

Despite this elevated risk, lifestyle modification, in particular weight loss, has been shown to be associated with better control of diabetes and and a reduction in cardiovascular risk factors.

The evidence from trials in overweight, type 2 diabetic patients have demonstrated that GLP-1 agonists such as semaglutide, achieves superior and clinically meaningful reductions in body weight in comparison to a placebo.

However, most of the weight loss clinical trials have included a lifestyle intervention to support patients but, in the absence of such support, GLP-1 agonist-associated weight loss is no better than that achieved with other agents such as metformin.

In the current study, US researchers from the university of Pittsburgh, sought to better understand the level of weight loss provided by GLPl-1 agonists when used in clinical practice, in other words, when no specific behavioural weight loss intervention is provided.

The team retrospectively examined the electronic health records of those prescribed any drugs from the GLP-1 agonist class and the subsequent weight loss after 72 weeks of therapy.

GLP-1 agonists and real-world weight loss

Outcomes were available for 2,405 participants with a mean age of 48 years (47.4% male) and of whom, 92.1% had type 2 diabetes and mean, baseline body mass index of 37.

Only 8 weeks after the first dispensing of a GLP-1 agonist, the mean weight loss was 1.1% and this increased to 2.2% after 72 weeks. However, some patients did even better. For instance, 11.2% had lost at least 5% of their body weight after 8 weeks but after 72 weeks, this proportion increased to just over a third (33.3%). In fact, at the 72 week mark, nearly half of the entire cohort (42.7%) had lost weight with a small proportion of patients (10.5%) managing to lose 10% or more of their body weight.

The authors concluded that the use of GLP-1 agonists prescribed at standard doses led to a modest degree of weight loss in a real-world setting and in the absence of any specific patient support.

White GE et al. Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: A retrospective cohort study. Obesity (Silver Spring) 2023.

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