Weight Loss Before Bariatric Surgery in T2DM: GLP-1 Agonist Gets it Done

February 2, 2015

Pre-surgical weight loss in obese patients with type 2 diabetes reduces perioperative risk. The dual benefits of GLP-1 agonists offer promise to this hard-to-treat population.

Bariatric surgery constitutes a powerful option to ameliorate severe obesity and type 2 diabetes. Given the growing global incidence of both chronic diseases, strategies that may augment the benefits of bariatric surgery in patients with obesity and type 2 diabetes need to be further explored. The current study is a profitable beginning.The slides above highlight a study in which the GLP-1 receptor agonist exenatide improved metabolic control and resulted in significant weight loss in obese patients with type 2 diabetes scheduled for bariatric surgery.Â SourceIglesias P, Civantos S, Vega B, et al. Clinical effectiveness of exanatide in diabetic patients waiting for bariatric surgery. Obes Surg.Â 2015;doi:10.1007/s11695-014-1563-9. (Subscription required)

Bariatric surgery is most effective treatment for severely obese patients (BMI â¥35 kg/m2) with type 2 diabetes (T2DM) GLP-1 RAs improve glycemic control, promote weight loss in T2DM patients

Uncontrolled prospective study of 100 patients with T2DM waiting for bariatric surgery. Participants: age 18 to 65 years, BMI of â¥35.

Intervention: exenatide 5 Âµg bid for 4 weeks; increase to 10 Âµg bid if well tolerated. Metformin and/or sulfonylurea adjusted to avoid hypoglycemia. All patients given recommendations on healthy lifestyle behaviors. Primary endpoints: changes in weight, HbA1c after 6 months of treatment.Secondary endpoints: changes from baseline in TGs, BP, waist circumference.

BMI: 40.9Â±4.49 kg/m2.HbA1c: 7.3Â±1.36%. Mean duration T2MD: 4.1 years. Data collection: 1, 3, and 6 months

Mean weight loss: 3 months, 8.9 kg; 6 months, 12.5 kg (p

42% achieved BMI

"In our study, weight loss was seen in those patients with higher baseline weight, so it would be reasonable to consider exenatide treatmentÂ as a new option for high-risk super-obese patients, in order to reduce their surgical risk." Study author Paloma Iglesias, MD, Hospital Rey Juan Carlos, Madrid, Spain

"Based on our observations, GLP-1 agonists could potentially reduce surgical risk of bariatric surgery in patients with morbid obesity and type 2 diabetes with the hypothetical advantage of avoiding the negative effects of a preoperative low-calorie program, as undergoing surgery in a catabolic state," the researchers wrote. "Randomized trials and cost-effectiveness studies to further define the potential role of GLP-1 agonist before bariatric surgery are warranted."