Is Weight Loss in Patients with Diabetes a Matter of Mind Over Medicine?

Results from a 104-week phase 3 study may have implications for the way patients with type 2 diabetes mellitus (T2DM) tackle weight loss.

Lead author Shana Traina, PhD, and colleagues examined the complex relationship between patients, medications (canagliflozin and glimepiride, two medications commonly used to treat T2DM that typically have conflicting effects on weight loss), and factors affecting patients’ decisions to engage in healthier behavior. The findings were presented at the American Diabetes Association 75^th Scientific Sessions in Boston, MA.

“T2DM treatment options that are associated with weight loss may encourage performance of diabetes self-care behaviors,” Traina, PRO Director at Janssen Pharmaceutical Companies of Johnson & Johnson, told MD Magazine.

Weight in general can have an effect on an individual’s psychological being; patients with diabetes may experience more of a change on their quality of life. Canagliflozin, a sodium glucose co-transporter 2 inhibitor, has been associated with weight loss while many patients taking glimepiride experience weight gain. The researchers analyzed how the 2 medications related with the particular stage patients are on (or not on) in the journey to a healthier lifestyle.

The transtheoretical model (TTM) was used to separate the 1,182 patients with type 2 diabetes into groups based on their readiness to change (RTC) for a healthier lifestyle — including diet, exercise, and weight loss.

Pre-Action Stage:

1. Precontemplation: A healthier lifestyle has not been considered
2. Contemplation: Thinking about making a healthier change
3. Preparation: Planning to change but have not yet put into action

Action Stage:

1. Action: Beginning to change behavior
2. Maintenance: Stabilizing behavior and avoiding relapse into former habits

The participants — 802 of whom were randomly assigned canagliflozin (100 or 300 mg) and 380 glimepiride – were followed for 2 years. The key findings were noted at the 36-week mark and revealed the percentage of participants in the “Action” phase.

Diet:

• Canagliflozin: 77.6%
• Glimepiride: 72.4%

Exercise:

• Canagliflozin: 66.5%
• Glimepiride: 63.9%

Weight Loss:

• Canagliflozin: 72.2%
• Glimepiride: 65.3%

“Rather than only considering weight as a risk factor for future micro- and macro-vascular complications,” Traina explained. “We hope that healthcare professionals will also understand weight as a process that people with type 2 diabetes mellitus are experiencing and using to make decisions about whether they will perform diabetes self-care behaviors.”

The results showed that, on average, for each 3 kg (about 6.6 pounds) a patient lost their happiness improved by 30%. Even though patients taking canagliflozin experienced an average weight loss of 3.4 to 4 kg (about 7.49 to 8.8 pounds) and those on glimepiride saw an average weight gain 0.7 kg (about 1.54 pounds) of after one year, subjects in both groups who continued in the Action phase saw a greater weight loss overall.

“The findings presented in our poster suggest that weight loss may encourage people to start and continue to perform diabetes self-care activities like making healthy food choices and increasing their physical activity,” Traina concluded.