Treating Overweight/Obese Patients With Comorbidities

T2DM: Overweight/obese patients with T2DM should use antidiabetic medications with additional weight loss-promoting actions, such as glucagon-like peptide-1 (GLP-1) analogues, or sodium-glucose-linked transporter-2 (SGLT-2) inhibitors, and pramlintide, in addition to metformin. The dipeptidyl peptidase IV (DPP-4) inhibitors may lead to minimal weight change. α-glucosidase inhibitors may also lead to small change in weight. Metformin, incretin-based medications and SGLT-2 inhibitors are also unlikely to cause exercise-related hypoglycemia.11-16 Antidiabetic drugs that lead to weight gain include insulin, sulfonylureas, and other insulin secretagogues, like glitinides and thiazolidinediones.1 Insulin therapy is often associated with weight gain.17 Overweight/obese patients requiring insulin therapy should also take metformin, pramlintide, or GLP-1 agonists to mitigate insulin-related weight gain.18,19 Basal insulin is preferable to premixed insulins or combination insulin therapy.20,21

Cardiovascular Disease and Hypertension: Overweight/obese patients with T2DM and hypertension should take angiotensin-converting enzyme (ACE) inhibitors, angiotensive receptor blockers (ARBs), and calcium channel blockers, rather than β-adrenergic blockers as first-line therapy.22 Sympathomimetic medications (eg, lorcaserin and orlistat) should be avoided in patients with cardiovascular disease.23

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