The Role of Anti-Obesity Medication in Prevention of Diabetes and Its Complications

Abstract

Diabetes is prevalent in obese population, and obesity management is the first step in preventing diabetes. Traditionally, lifestyle modification including reduced-calorie diet, physical activity, and behavior intervention is the core of obesity management. However, pharmacotherapy is frequently required in addition to the lifestyle modification for effective reduction of body weight. There are five classes of anti-obesity medications approved by the U.S. Food and Drug Administration for chronic treatment used in obesity management. As the goal of obesity management is to prevent obesity-related comorbidities, clinical trials were conducted to evaluate the effect of anti-obesity medications on cardiovascular risk factors including hyperglycemia. Orlistat and liraglutide have been tested for their effect on diabetes prevention as a primary outcome. Cardiovascular safety studies were conducted for lorcaserin and liraglutide (as an anti-diabetic medication). In addition, there are many indirect evidences of the role of anti-obesity medications on diabetes prevention and its microvascular and macrovascular complications. This review focused on current evidences of anti-obesity medications related with diabetes, which is a major complication of obesity.

Keywords: Cardiovascular disease; Diabetes complications; Diabetes mellitus; Drug therapy; Obesity.

Figure 1

The role of anti-obesity medications on diabetes complication risk management. Data from XENDOS (orlistat), CONQUER (phentermine/topiramate extended-release [ER]), BLOOM (lorcaserin), COR (naltrexone SR/bupropion SR), and SCALE (liraglutide). ER, extended-release; SR, sustained release; PP2, postprandial 2 hour-plasma glucose; FPG, fasting plasma glucose; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; XENDOS, Xenical in the Prevention of Diabetes in Obese Subjects; COR, Contrave Obesity Research.