Treating the Obese Diabetic

Julia Kenkre; Tricia Tan; Stephen Bloom


Expert Rev Clin Pharmacol. 2013;6(2):171-183. 

In This Article

Effect of Current Diabetic Medications on Weight

The current medications used to manage hyperglycemia in Type 2 diabetics have varying effects on weight (Table 1).[2–18,115]


Metformin, as per current American Diabetes Association (ADA) and European Association for the Study of Diabetes recommendations, is the first-line medication used for those with Type 2 diabetes and has an established safety record. It inhibits hepatic gluconeogenesis, and to a lesser extent glycogenolysis, but also increases insulin sensitivity.[19,20] The UKPDS 34 study suggested improved cardiovascular (CV) outcomes in those taking metformin, although recent meta-analyses have failed to confirm this.[21,22] Metformin not only offers useful glycemic control but has also been shown in some trials to induce weight loss,[23] although two meta-analyses comparing metformin to placebo have shown its overall long-term effect appears to be weight neutral.[3,24] Metformin has been in use clinically since the 1950s (in the USA since 1995), so it has a well-understood long-term safety profile with the most common side effects being transient gastrointestinal symptoms. Lactic acidosis is a rare side effect but cases have been reported in the literature.[25]