This transcript has been edited for clarity.
Something different happened at the Scientific Sessions of the American Diabetes Association this year. The focus has shifted from glucose to the treatment of obesity. Now, don't get me wrong, I've spent my career helping people deal with being overweight or obese, and I really believe that weight loss is good for you. It helps deal with all sorts of issues and I think it's important.
We now have these wonderful new agents that can help people lose weight. In fact, at these meetings, we're hearing even more results about people going ever lower in terms of weight loss and that there are newer drugs in the pipeline that are going to be three different hormones together to give even more weight loss, and isn't this amazing? I think it is amazing, but I'm not entirely sure what I think of it all.
First, I think glucose still matters. I have people who are on whatever agent they're on, such as tirzepatide, and they've lost 40 or 50 lb, but they're still on insulin and they still need to have their glucose managed. I have people who've lost weight on these agents but then seem to reach a plateau, and then some of them start to regain the weight, their hunger comes back, and I have no idea what the long-term benefit of any of this is going to look like.
Ironically, when meeting my colleagues, many of whom don't have diabetes, most of them are on semaglutide. I have all sorts of people I know here who were taking these agents themselves, and they're all diabetes doctors. We all have drunk the Kool-Aid.
I want to make sure we're not forgetting about glucose because it doesn't go away, and it still causes all sorts of problems. Now, if we can prevent diabetes this way, great. Once people have diabetes and hyperglycemia, we know that many of them don't reach their targets. We can't forget about glucose.
I'm going to tell you about a patient of mine who has type 2 diabetes and an A1c of over 12%, and she's struggling. She's on insulin, but she doesn't like giving the insulin. She gained all the weight when she went on antipsychotic drugs. She really struggles with it. She's in so much trouble. She has bad lung disease; she's on oxygen. She looks terrible, sort of gray.
Her dad brought her to see me. Her health plan didn't, at that point, allow her to use glucagon-like peptide 1 (GLP-1) receptor agonist therapy. The dad said, "My daughter is dying. She's dying because she is so obese, and they won't even take her for bariatric surgery because her glucose levels are too high."
I looked at her and I said, which is what I always say, "If you work with the medications, if you work with lifestyle change, and if you make insulin dose adjustments, we can get you to where you want to be."
First, we put her on semaglutide, but that seemed to have no impact on her weight. Then I put her on tirzepatide, which people are paying for out of pocket. I saw her the other day on a Zoom call, and she had lipstick on and she was smiling. She still had her oxygen on, but she was smiling. This was a whole new person.
I asked, "What happened?" She said that the tirzepatide was really working. She now weighs only 414 lb, which is the first time in years she's lost weight. Just losing 26 lb is changing her life. Her glucose levels have come down, and she now is a candidate for bariatric surgery. She is going to bariatric surgery classes. Interestingly, in this group, she's actually working with other people who are also obese. She has created this network of people and it's making a huge difference.
I think that what we can do for our patients now is so different from what we could do before because of these agents. I'm not sure that these drugs alone are the answer, because we still have to deal with glucose and we still have to get people's glucose levels down if these agents aren't enough to lower their glucose levels by themselves.
We have to remember that a healthy lifestyle still matters. We still need to engage patients to have them engage in physical activity. We need to educate them about how to have a healthy lifestyle, how to eat well, and how to use these agents to have an altogether healthier state of being, because again, we don't know the long-term effects of these agents. If, along the way, people can learn new healthy habits and then maintain them over time, it's a real win.
Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.
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Cite this: Shifting Focus on Obesity: Don't Forget About Glucose - Medscape - Jul 14, 2023.
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