How Diabetes Medications Affect Your Appetite
Many of my patients with type 2 diabetes are overweight or obese. For them, losing weight is an important way to gain better control over their diabetes and improve their health in general.
But losing weight by diet and exercise alone can be very difficult. In fact, the latest science about obesity suggests the hormones controlling appetite in an obese body are dysregulated. To put it very simply, that means obese patients’ brains may tell them they’re hungry when they’re actually full. It shows us we may need pharmacological assistance to rebalance leptin, ghrelin, and other appetite hormones to get the body functioning correctly.
While researchers are still learning more about appetite hormones, many of my patients wonder about the effect of their diabetes medications on their appetite. While the more standard diabetes treatments don’t suppress appetite or cause weight loss, newer therapies have come to the market in recent years that do offer these benefits. However, they’re so new that they lack long-term data on safety. Until we get more information, I tend to stick with the standards for most of my patients. Still, there are niches these drugs can fill.
The classic treatment prescribed for diabetes, insulin, has the potential to cause weight gain, and doesn’t suppress appetite–which can be a huge drawback to insulin. Another traditional therapy, metformin, also doesn’t suppress appetite. Metformin, however, can indirectly make it easier for you to lose weight by helping you overcome insulin resistance and lower blood sugar.
A new class of drugs called GLP-1 (glucagon-like peptide-1) receptor agonists has been shown to suppress appetite and cause weight loss. In one study, participants taking GLP-1 receptor agonists lost between 3.3 and 5.5 pounds over 30 weeks.
GLP-1 is a type of hormone called an incretin; it tells our bodies we’re full. It is released by the small intestine as the food we eat gets digested. GLP-1 receptor agonists mimic and enhance the activity of GLP-1. GLP-1 works by helping the pancreas secrete more insulin; insulin then interacts with other appetite-regulating hormones to make us stop eating and feel sated.
Currently, the Food and Drug Administration (FDA) has approved several GLP-1 receptor agonists to treat type 2 diabetes:
- Exenatide (Byetta, Bydureon)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- Liraglutide (Victoza)
- Lixisenatide (Adlyxin)
Another new class of drugs, called DPP-4 (dipeptidyl peptidase-4) inhibitors, suppresses appetite in a similar way. DPP-4 inhibitors work to increase levels of incretins, like GLP-1, leading to feelings of fullness and suppressed appetite. The DPP-4 inhibitors aren’t as effective as GLP-1 receptor agonists, however, because they don’t augment the effect of GLP-1; they just increase the amount of time GLP-1 works in our bodies after a meal.
The FDA has approved four DPP-4 inhibitors to date:
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Tradjenta)
- Alogliptin (Nesina)
Patients should understand these medications do come with side effects, and their doctor may feel other diabetes treatment options are best for their individual situation. In addition, it’s important that patients don’t look at their medications as an answer to weight loss or as the only way to resolve their diabetes; diet and exercise are key parts of a diabetes treatment plan. Successful diabetes management and weight loss results from a combination of diet, exercise and medications.