American Association of Clinical Endocrinology Annual Meeting

American Association of Clinical Endocrinology Annual Meeting

Perspective from W. Timothy Garvey, MD
May 15, 2014
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Weight loss drugs offer promising solution for prediabetes compared with glucose-lowering methods

Perspective from W. Timothy Garvey, MD
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LAS VEGAS — In looking at the population of patients classified as prediabetic, one expert here suggested that antiobesity medications may have a more preventive effect on the transition to overt diabetes than traditional antihyperglycemic drugs.

“Typically, one thinks of antihyperglycemic therapies in the prediabetic patient. ... A more promising area for normalizing glycemia are the pharmacologically assisted weight loss interventions, which are beginning to produce extremely outstanding remissions in prediabetes and prevention to overt type 2 diabetes,” Alan J. Garber, MD, chief medical editor for Endocrine Today, said during his presentation at the AACE 23rd Annual Scientific & Clinical Congress. “Perhaps antiobesity therapies are a better approach for patients since it gets more to [the] etiology of the underlying deterioration of beta-cell function.”

Garber presented the American Association of Clinical Endocrinology’s algorithm for treating type 2 diabetes, and explained that this treatment begins with the patient with prediabetes, and is dependent upon a person’s metabolic complications due to their overweight or obesity.

“The algorithm is really an attempt to move beyond the glucose-centric view of the patient with diabetes and take a holistic view of what’s happening to this patient. And it includes the patients with prediabetes and obesity because ... there’s no question that the antecedent metabolic changes which set in motion the eventual outcome of type 2 diabetes must be recognized early on  … before there is significant beta cell damage if one is to reverse the process,” Garber said. “In order to justify taking it up a notch to either pharmacologically-assisted weight loss or surgical interventions, one really should have some structured approach in mind based upon the number of complications.”

The currently available antiobesity medications, such as lorcaserin (Belviq, Eisai) and toparimate (Topamax, Janssen), have shown a 10% reduction in weight loss, according to Garber, and this reduction could “essentially rid most patients of their prediabetic states and prevent their deterioration to overt diabetes.”

These newer methods of addressing obesity are justified when a patient does not respond to traditional lifestyle modifications, he said.

“Strictly blood sugar lowering drugs ... will increasingly become passé as we develop more assertive ways of dealing with the underlying obesity that’s driving the deterioration to type 2 diabetes.”

For more information: Garber AJ. W22. Presented at: AACE 23rd Annual Scientific & Clinical Congress; May 13-18, 2014; Las Vegas, Nevada.

Disclosures: Garber reports financial relationships with Lexicon Pharmaceuticals, Merck & Co., Novo Nordisk, and Santarus.