You might have come across some online discussions about diabetes medications for weight loss called glucagon-like peptide-1 (GLP-1) receptor agonists. Some of the medications in this group include semaglutide, dulaglutide and liraglutide among others.
What is GLP-1?
GLP-1 is a naturally occurring hormone within the body which plays a role in maintaining blood glucose levels. What it does is manage glucose metabolism and stimulate the release of insulin when the blood sugar level rises.
Pharmaceutical companies have engineered synthetic GLP-1 medications that replicate this hormone’s functions. These medications which are normally administered through injections, are known as GLP-1 receptor agonists. They perform similar tasks as GLP-1 hormone which may result in weight reduction.
- Controlling hunger
- Regulating blood sugar levels
- Slowing the digestion process
What are the Most Effective Diabetes Medications for Weight Loss?
In June 2021, the U.S. Food & Drug Administration (FDA) approved semaglutide, marketed under the name Wegovy, specifically for weight loss in adults. In December 2022, the same drug was approved for use in adolescents. According to the FDA, this self-administered injection can be prescribed if you meet one of the following criteria:
- A body mass index (BMI) of 27 kg/m2 (and up) with at least one weight-related health condition
- A BMI of 30 kg/m2 or higher
Weight loss outcomes can vary depending on the specific GLP-1 medication used and the dosage. Research has shown that all GLP-1 drugs can lead to weight loss, with liraglutide users generally losing about 10.5 to 15.8 pounds (4.8 to 7.2 kilograms). Studies have also demonstrated that individuals using semaglutide in combination with lifestyle changes lost approximately 33.7 pounds (15.3 kilograms), compared to just 5.7 pounds (2.6 kilograms) in those who did not use the drug.
GLP-1 Agonists
There are several GLP-1 receptor agonists approved by the FDA for the treatment of Type 2 diabetes. GLP-1 agonists for diabetes treatment are generally administered via injections, either weekly or daily.
Ozempic (semaglutide)
Ozempic is primarily a diabetes medication, but it has gained popularity for its weight loss benefits. The FDA first approved this injectable treatment for diabetes in 2017. In 2021, the agency approved a higher dose of its active ingredient, semaglutide, for obesity management, marketed under the brand name Wegovy. Since then, the drug has gained widespread attention and public figures like Elon Musk have mentioned using Wegovy, while discussions about Ozempic have become common online, including platforms like TikTok, where the hashtag #Ozempic has accumulated over 273 million views.
Rybelsus (semaglutide)
Rybelsus, Ozempic, and Wegovy share the same active compound—semaglutide—placing them within the GLP-1 receptor agonist class.
These medications function similarly in the body by prompting the pancreas to release insulin and curbing glucose production in the liver after eating. They also slow down digestion so you feel full longer.
However, they can cause similar side effects, including nausea, diarrhea and vomiting. The starting dose is often low and is gradually increased to the desired dosage, so your body can adapt and reduce the likelihood of side effects.
Despite these similarities, there are key differences among them. For one, Wegovy and Ozempic are administered via weekly injections, while Rybelsus is an oral tablet taken daily. Also Wegovy and Ozempic are approved by the FDA for cardiovascular benefits in certain individuals with heart disease, while Rybelsus is not.
Trulicity (dulaglutide)
Trulicity (dulaglutide) is an injectable treatment that improves blood sugar control in adults with Type 2 diabetes. It may also reduce the risk of serious cardiovascular events, such as heart attacks or strokes, in those with Type 2 diabetes who have cardiovascular disease.
Administered once a week under the skin, ideally on the same day each week at the same time, each injection helps maintain blood sugar levels for the entire week. Trulicity is specifically effective in individuals with Type 2 diabetes.
Research has shown that, on average, people may lose between 2-6 lbs while taking Trulicity. However, weight gain has been observed in some individuals.
Specific studies on dulaglutide, the active ingredient in Trulicity, revealed:
A greater average weight loss (3.23 kg) compared to insulin glargine in 588 patients also on insulin lispro. Nearly half (49%) of the patients using dulaglutide did not gain weight, compared to only 19% of those on insulin glargine.
In the AWARD-1 trial, a slight average weight gain of 0.2 kg was noted with dulaglutide 0.75 mg.
In the AWARD-3 trial, weight loss with dulaglutide was comparable to metformin.
The AWARD-4 trial found that dulaglutide 1.5 mg resulted in a weight loss of 0.87 kg, while dulaglutide 0.75 mg had a neutral effect on weight at 26 weeks.
The AWARD-6 trial showed an average weight loss of 2.8 kg with dulaglutide 1.5 mg, compared to 3.6 kg with liraglutide.
In the AWARD-11 trial, after 36 weeks, the average weight loss was 4.7 kg (10.4 pounds) with dulaglutide 4.5 mg, 4 kg (8.8 pounds) with dulaglutide 3 mg, and 3 kg (6.8 pounds) with dulaglutide 1.5 mg.
While treatment with GLP-1 receptor agonists generally leads to weight loss, results can vary widely among individuals.
Victoza (liraglutide)
Victoza is an injectable medication approved by the FDA to lower blood sugar levels in individuals aged 10 and up with Type 2 diabetes. It is also approved to reduce the risk of cardiovascular events, such as heart attacks or strokes for those with diabetes.
It’s administered once daily through a subcutaneous injection. Each injector pen contains 18 mg of liraglutide, and it can be dosed at 0.6 mg, 1.2 mg, or 1.8 mg. Often the treatment starts at 0.6 mg, though this dose isn’t sufficient for diabetes management. After a week, the dose may be increased to 1.2 mg, and then potentially to 1.8 mg after another week, depending on the healthcare provider’s recommendation.
Mounjaro
Mounjaro (tirzepatide) functions similar to GLP-1 receptor agonists, but it offers an additional benefit. It mimics the action of GLP-1 along with another hormone known as glucose-dependent insulinotropic polypeptide (GIP). This dual action can enhance blood sugar-lowering effects more effectively. It also has the potential to result in more significant weight reduction compared to GLP-1 agonists. Research has shown that individuals using Mounjaro experienced an average weight loss ranging from 16 to 25 lbs.
The active component in Mounjaro, tirzepatide, is also approved for weight reduction, but under a different brand name, Zepbound. Like the GLP-1 receptor agonists mentioned earlier, using Mounjaro for weight loss is considered an off-label application.
Metformin
Metformin is another medication for diabetes that may induce weight loss as a side effect in some individuals. It’s among the most frequently prescribed diabetes treatments because it effectively lowers blood sugar levels and is available in lower-cost generic forms. Metformin primarily reduces the amount of glucose produced and absorbed by the body, while also increasing the body’s sensitivity to its own insulin.
Weight loss associated with Metformin is generally more modest compared to the medications mentioned above. Not everyone will lose weight while taking it, but studies indicate that some individuals may shed up to 6 lbs after a year of treatment.
SGLT2 Inhibitors
The sodium-glucose cotransporter 2 (SGLT2) inhibitors can also contribute to weight loss. These drugs work by removing glucose from the bloodstream through urine. With less glucose circulating in the blood, there’s a reduced amount available for conversion into fat cells, potentially leading to modest weight loss in some people. Users of SGLT2 inhibitors might lose between 4 to 6 lbs while on these medications.
Examples of SGLT2 inhibitors include:
- Jardiance (empagliflozin)
- Farxiga (dapagliflozin)
- Invokana (canagliflozin)
Symlin
Symlin (pramlintide) is a synthetic version of the hormone amylin. Amylin slows the passage of food through the stomach and inhibits glucose production by the liver. Symlin works in the body similarly to amylin and can lead to weight loss of up to 4 pounds in most individuals with diabetes. For those who are both diabetic and obese, Symlin may help them lose up to 7 pounds.
What Happens If You Stop Taking the Medication for Weight Loss?
There’s a significant possibility that you will regain the lost weight if you stop using these medications. Research has indicated that individuals who discontinued semaglutide experienced a regain of about two-thirds of the weight they had initially lost. The medication not only helps you feel satiated and curbs hunger and cravings, but it also alters how your body manages fat. When the medication is no longer in use, the body tends to revert to its previous patterns of fat regulation.
At present, there are no generic versions of GLP-1 medications specifically approved by the FDA for weight loss. Due to the high demand and expense of these FDA-approved medications—especially if not covered by insurance—compounded versions have emerged in the market. Compounding involves the process of mixing or modifying the ingredients of one or more medications to create a new formulation. However, these compounded medications are not FDA-approved, which means their safety, efficacy, and quality have not been verified by the FDA.
It’s advisable to avoid using unregulated compounded medications for weight loss. Instead, discuss weight-loss options with your healthcare provider. While on GLP-1 medication, it’s crucial to be under a doctor’s supervision to ensure accurate dosing, monitor your progress and any side effects, and receive advice on necessary lifestyle changes, including diet and exercise.
Who Should Avoid GLP-1 Medications?
GLP-1 medications are not suitable for individuals who:
- Are pregnant or breastfeeding
- Have a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia
- These medications should also be used with caution if you have conditions like gastroparesis or pancreatitis.
Concerns About Long-Term Use of Diabetes Medications for Weight Loss
Although GLP-1 medications have shown promise for weight management, it’s natural to have questions regarding their long-term safety. Given that this class of medication has been under study for nearly two decades, there is substantial data supporting its long-term use. There are no major health concerns associated with chronic use of these medications for managing long-term conditions. Nonetheless, it’s important to maintain ongoing discussions with your healthcare provider to address any specific concerns you may have.
Lifestyle Changes with Diabetes Medications for Weight Loss
Often we overlook the necessary lifestyle changes that are needed to complement medication to get optimal results. The medication should be seen as a tool and not a cure-all solution. The healthy habits you’ve practiced in the past, such as adjusting your diet, engaging in physical activity, and ensuring adequate sleep, are important when using this medication.
Also you need to recognize that semaglutide is prescribed for long-term weight management and is approved for extended use. It’s not intended for short-term use, such as trying to lose weight quickly for a specific occasion.