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Weight control in type 2 diabetes

Weight management in T2D

Read time: 30 mins
Last updated:22nd Feb 2023
Published:22nd Feb 2023

Weight control is an important aspect of preventing or managing type 2 diabetes (T2D). Being overweight or obese is a major risk factor for developing T2D. Maintaining a healthy weight through a combination of diet, lifestyle factors and medication can help prevent, delay or improve T2D. Losing weight can lower the body's resistance to insulin, allowing for better blood sugar control. This can lead to a decrease in the need for diabetes medication or even the ability to stop taking medication altogether. Additionally, weight loss can improve overall health and reduce the risk of complications related to diabetes.

Weight control in T2

Prevalence of obesity in T2D

Obesity has been recognised by the American Medical Association (AMA) and the European Commission as a noncommunicable disease with several pathophysiological aspects, including diabetes1,2. Obesity has nearly tripled worldwide in all age groups since 1975, including in children, adolescents and young adults3.

Obesity is much more common in children, adolescents and young adults with T2D than in older adults (> 80% vs 56%, respectively)4

Due to an increase in the prevalence of obesity in those yet to reach adulthood, T2D has become a concern in children and adolescents.

High BMI increases the risk of T2D

For both men and women, body mass index (BMI) is one of the leading risk factors for disability-adjusted life years (DALYs) of early-onset T2D globally in 2019 (Figure 1)5. It was estimated that the number of global deaths and DALYs attributable to a high BMI had more than doubled from 1990–20176.

An increase in both BMI and glycated haemoglobin (HbA1c) levels also increased the risk of developing diabetes from prediabetes7


Figure 1. High body mass index is the top risk factor globally (top) and classified by gender (bottom) attributable to T2D burden (Adapted5).
DALY, disability-adjusted life year.

Obesity and T2D progression

Obesity is an important driver for the development of beta cell dysfunction, as defined by hyperinsulinemia and impaired glucose-stimulated insulin secretion, and the progression of T2D as illustrated in Figure 28. Because excess fat worsens diabetes, losing weight can remarkably improve the condition.


Figure 2. Obesity is a key contributing factor to the progression of T2D8.
ER, endoplasmic reticulum; GSIS, glucose-stimulated insulin secretion.

Lifestyle factors for T2D prevention

T2D is preventable through lifestyle changes, such as weight loss through diet changes that adhere to current recommendations for fat quality, fibre intake, increased use of wholegrain products, fruit and vegetables, and increased physical activity9.

The degree of long-term weight loss and adherence to lifestyle changes is directly relevant to T2D risk reduction, and this preventive effect has been shown to last for many years after active intervention9

A pooled analysis of the European Diabetes Prevention Study adds to the evidence for T2D prevention through lifestyle changes. Participants who lost 5% of their body weight in one year had a 65% lower incidence of T2D, and maintaining a 5% weight loss for two and three years further decreased the risk of T2D10.

Current guidelines for the prevention of T2D in people at high risk are based on achieving moderate weight loss (5–10% weight loss) via dietary change and increasing physical activity

Figure 3 shows the current dietary strategies to improve the condition of T2D11,12.


Figure 3. Dietary strategies are shown to improve (purple) or provide some evidence of improvement (blue) and potential for improvement (orange) in T2D13.
IFG, impaired fasting glucose; IGT, impaired glucose tolerance; TDR, total diet replacement; VLED, very low energy diet (< 800 kcal/day).

The Finnish National Diabetes Prevention Program14 of weight reduction, healthy diet and physical activity for a year included 10,149 people at high risk of T2D (average BMI > 30 kg/m2). Among the 2,730 participants who completed the intervention (median follow-up, 7.4 years), those who lost 2.5–4.9% weight and ≥ 5% weight had a 37% and 29% lower incidence of T2D respectively, than those who did not lose weight.

Keeping weight stable in adulthood is linked to a lower risk of developing diabetes; whole-population weight maintenance strategies have the potential to prevent the disease15

In a participant-level evaluation of the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (NDPP)16, the lifestyle change program is one of the key components that provides:

  • A trained lifestyle coach – assists participants in learning new skills, encourages them to set and achieve goals and keeps them motivated. The coach will also facilitate discussions and contribute to making the programme enjoyable and engaging
  • A CDC-approved curriculum – with lessons, handouts and other resources to help participants make healthy changes
  • Group support over a year – a support group of people with similar goals and challenges

Participants in CDC-recognised lifestyle change programmes who lost 5–7% of their body weight and added 150 minutes of exercise per week reduced their risk of developing T2D by up to 58%. Even a decade later, programme participants were one-third less likely to develop T2D than non-participants.

The NDPP programme can also reduce the chances of having a heart attack or stroke, improve health and even reverse a prediabetes diagnosis14

Lifestyle factors for T2D remission

If obese/overweight people with T2D are able to substantially decrease their body weight, a significant proportion can become non-diabetic. According to a population-based study conducted in Europe, losing 10% or more of one's body weight in the first year after a T2D diagnosis increased the chance of remission by double17.

Remission was also demonstrated in the DiRECT trial18, which included 306 patients with T2D from the United Kingdom. For 3–5 months, half of all meals were replaced with a nutritionally balanced liquid diet (825–853 kcal/day):

  • At 12 months, the intervention group's mean weight had decreased by 10%, and 46% of the participants had achieved diabetic remission
  • At 24 months, the intervention group's average weight loss was 7.6%, and 36% of participants obtained diabetic remission

Post hoc analysis of the DiRECT trial18 revealed that 24% of participants maintained a 10 kg weight loss, and 64% remained in remission. At 8 years, approximately 50% of intensive lifestyle intervention participants lost and maintained 5% of their initial body weight, while 27% lost and maintained 10%.

Additional weight loss benefits in people with T2D are documented by secondary analyses of the Look AHEAD trial and other significant cardiovascular outcome studies, including better mobility, physical and sexual function, and health-related quality of life (QoL)19. Additionally, certain subgroups, such as those who lost more than 10% of their body weight and those with moderately or poorly controlled diabetes (HbA1C > 6.8% at baseline), had better cardiovascular outcomes19.

The magnitude of weight loss, regardless of diet (as long as it is sustainable), is the most important factor in achieving diabetes remission13,18

If lifestyle interventions alone are insufficient to achieve weight loss, pharmacological and surgical treatments may be considered.

Communication is essential

Patient-centred communication has been linked to better disease knowledge, self-care, QoL and metabolic control in T2D20-22

Consistent with this evidence, leading organisations, such as the American Diabetes Association (ADA)23 and the International Diabetes Federation (IDF)24, are currently advocating for patient-centred communication in diabetes management.

The ADA's current clinical practice recommendations state that a person-centred communication style using inclusive, non-judgmental language and active listening to elicit individual preferences and beliefs and assess potential barriers to care should be used to optimise health outcomes and health-related QoL. The ADA encourages the use of person-centred, non-judgmental language that fosters collaboration between individuals and healthcare professionals (HCPs), including person-first language (e.g., ‘person with obesity’ rather than ‘obese person’)19.

It is critical for HCPs to develop professional communication skills and a fundamental mindset based on a person-centred approach before introducing specific techniques and tools25. Some of the constraining and facilitating factors experienced by participants during clinical encounter communications include26:

  • Power imbalance vs partnership in decision making in the patient-provider relationship
  • Socioeconomic factors, health literacy, responsibility related to disease and treatment
  • Quality of communication and consistency in providing information

In the UK, a Language Matters Working Group has been set up by NHS England to improve awareness of the impact words may have on the care of people living with diabetes (Table 1)27.

Table 1. NHS recommendations for improving communication with people with diabetes27.

Seek to be more Seek to be less
(e.g., ‘it sounds as though your
diabetes is really hard to manage at the moment’)
(e.g., ‘you’re in denial’)
Empowering and inclusive
(e.g., ‘what
changes do you feel are needed right now?’)
Shaming or blaming
(e.g., ‘it’s being so
overweight that is causing you to have all these
(e.g., ‘I appreciate you coming
to our appointment today’)
(e.g., ‘you must take your
medications properly in future’)
Trust building
(e.g., ‘I will definitely
discuss your situation with xx and let you know
what they say’)
(e.g., ‘before you come to
see me, I want you to take 4 blood tests a day for
3 days, so I can check what’s going wrong’)
Person centred
(e.g., ‘what thoughts
have you had yourself about your recent glucose
(e.g., ‘you aren’t meant to
take your insulin like that’)
(e.g., ‘I can see the effort
you’re putting in, keep up the great work!’)
(e.g., about someone,
‘I don’t think they’d get much from a diabetes
education class’)
(e.g., ‘yes, your HbA1c this time is
higher than recommended’)
(e.g., ‘people from xx
background often dislike the idea of injections’)
(e.g., ‘diabetes brings lots of
ups and downs, but it is manageable and there
are lots of ways you can deal with it’)
(e.g., ‘I think you’d cope
best with once a day insulin, as it’s simpler’)
(e.g., ‘now doesn’t
sound the best time to be concentrating on your
(e.g., about someone, ‘no-one in
that family has ever taken much notice
of their diabetes, they will be the same’)
(e.g., ‘what makes you say,
‘I feel like a failure?’’)
(e.g., ‘I think you’re making
the wrong decision’)
(e.g., ‘let me talk you
through the different medications and then see
what you think would suit you best’)
(e.g., ‘If you don’t improve
your control you will end up on insulin’)
Congruent words and behaviours
(e.g., looking at the person when
welcoming or asking questions)
Culturally competent
(e.g., exploring
individuals’ cultural, religious/faith and spiritual
beliefs about diabetes)


Pharmacological weight loss strategies for T2D

Professor Caroline Apovian gives an overview of the pharmacological weight loss strategies for type 2 diabetes (T2D) in the video below.

Pharmacological weight loss strategies for T2D

Treatment considerations for weight loss in T2D

Healthcare professionals (HCPs) should take into account each medication's impact on weight when planning treatment programmes because there are various effective treatments available. Below are the American Diabetes Association’s (ADA) recommendations in obesity and weight management for the prevention of T2D19:

  • When choosing glucose-lowering medications for people with type 2 diabetes who are overweight or obese, consider the medication’s effect on weight
  • Whenever possible, minimise medications for comorbid conditions that are associated with weight gain
  • Obesity pharmacotherapy is effective as an adjunct to nutrition, physical activity and behavioural counselling for selected people with type 2 diabetes and a BMI ≥27 kg/m2; potential benefits and risks must be considered
  • If obesity pharmacotherapy is effective (typically defined as ≥5% weight loss after 3 months’ use), further weight loss is likely with continued use
  • When early response is insufficient (typically < 5% weight loss after 3 months’ use) or if there are significant safety or tolerability issues, consider discontinuation of the medication and evaluate alternative medications or treatment approaches

In the following video, Professor Caroline Apovian summarises clinical guideline recommendations when considering individual patient characteristics.

Clinical guideline recommendations based on individual patient characteristics

Medication that both encourages weight loss and lowers glucose levels is preferred when greater weight loss is the main therapeutic goal. In addition to managing hyperglycaemia, metformin is frequently used to promote moderate weight loss. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist therapies promote weight loss19. Figure 4 summarises the weight loss for the most commonly used diabetes medications. Real-world evidence shows that treatments of metformin plus sodium–glucose cotransporter-2 inhibitors (SGLT2i; 2.4%), SGLT2i (1.7%), and GLP-1 RA (1.6%) resulted in a greater reduction in body weight values than other antidiabetic groups28.


Figure 4. Overview of weight loss with commonly used antidiabetic medication29.

Primary Care Diabetes Europe treatment recommendations30 for patients with obesity are as follows:

  • Consider initiating metformin plus GLP-1 RA/SGLT2i rather than stepwise
  • Metformin as first-line therapy
  • GLP-1 RA or SGLT2i as second-line therapy
  • Where possible, avoid treatments that cause weight gain, including most sulfonylureas, glinides, pioglitazone and insulin
  • If basal insulin is required, consider fixed-ratio insulin/GLP-1 RA combinations, if available

A joint consensus report by the ADA and the European Association for the Study of Diabetes (EASD) on the management of hyperglycaemia in T2D states that weight reduction is a targeted intervention for managing T2D31

Figure 5 provides a schematic approach for the achievement and maintenance of glycaemia and weight management31.


Figure 5. Use of glucose-lowering medications in the management of obesity in T2D31.
CGM, continuous glucose monitoring; DPP-4i, dipeptidyl peptidase-4 inhibitors; DSMES, diabetes self-management education and support; GLP-1 RA, glucagon-like peptide-1 receptor agonists; HbA1c, glycated haemoglobin; SDOH, social determinants of health; SGLT2i, sodium–glucose cotransporter-2 inhibitors; TZD, thiazolidinedione.

GLP-1 RA for weight loss in T2D

In the following video Professor Caroline Apovian discusses recent changes to pharmacological weight loss intervention options, including both GLP-1 RAs and SGLT inhibitors.

Pharmacological weight loss interventions and strategies for type 2 diabetes

A meta-analysis of 34 trials comparing GLP-1 RAs (albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, and taspoglutide) with placebo or another GLP-1 RA in patients with T2D and poor control on oral agents (typically metformin) found that all approved GLP-1 RAs reduced weight compared with placebo, with little difference between individual agents32. In the comparative effectiveness trial (GRADE), treatment with liraglutide was associated with more weight loss (3.5 kg) than sitagliptin (2.0 kg), glimepiride (0.73 kg) or glargine (0.61 kg)33.

In a comparative effectiveness analysis of seven GLP-1 RAs from 64 trials, dulaglutide ≥ 1.5 mg, exenatide immediate-release (ER) and exenatide extended-release (ER), efpeglenatide, liraglutide ≤ 1.8 mg, liraglutide > 1.8 mg, lixisenatide and semaglutide < 2.4 mg or 2.4 mg subcutaneous (SC), semaglutide oral, and taspoglutide were all associated with significant weight loss when compared to placebo. Semaglutide (SC and oral) and liraglutide were the most effective GLP-1 agents for weight loss after at least 12 weeks of treatment34.

In a large real-world study (N = 2,405; mean age, 43 years; mean BMI, 37 kg/m2), treatment with GLP-1 RA resulted in a mean weight loss of 1.1% 8 weeks after treatment and 2.2% 72 weeks after treatment. About 800 patients had lost ≥ 5% body weight at 72 weeks35.

Results from another real-world study (N = 589; mean age, 54 years; mean BMI, 41.2 kg/m2) suggested that real-world benefits may be lower than those seen in clinical trials: 43.5% of participants had lost ≥ 5% of their body weight but 32.3% had gained weight. Most importantly, 45.2% of the cohort had discontinued the medication within 12 months, and 64.7% had discontinued the medication at 24 months36.

Dual-acting GLP-1 and GIP RA for weight loss in T2D

Dual-acting therapy GLP-1/GIP RA appears to be more effective than GLP-1 RAs alone in terms of weight loss. A recent meta-analysis of seven trials found that tirzepatide was more effective than GLP-1 RAs in reducing body weight; reductions ranged from 1.68 kg with tirzepatide 5 mg to 7.16 kg with tirzepatide 15 mg.37.

DPP-4 inhibitors vs GLP-1 RAs

GLP-1 RAs are generally preferred over dipeptidyl peptidase-4 (DPP-4) inhibitors due to greater HbA1c reductions and clinically significant weight loss observed in clinical trials – a mean weight loss of -0.79 to -6.1 kg was observed with GLP-1 RA and 0.0 to -1.9 kg was observed with sitagliptin. DPP-4 inhibitors have only a minor effect on endogenous GLP-1 levels, resulting in smaller glycaemic reductions with little impact on weight loss38.

SGLT1 and 2 inhibitors

A meta-analysis of 116 trials has shown a mean weight reduction of -1.67 kg with a SGLTi compared with placebo. Combined SGLT1/SGLT2i showed significantly greater weight reduction than SGLT2i alone, with a mean difference of -0.70 kg39.

Combination of GLP-1 RAs and SGLT2 inhibitors

According to a pooled analysis of eight trials, short-term GLP-1 RA/SGLT2i combination therapy may be a better option for inadequately controlled, overweight or obese patients with T2D who are more likely to achieve weight loss goals. The beneficial effects of weight loss are more pronounced than the individual monotherapies but became less significant after 1 year40.

Patient involvement in weight management

Professor Caroline Apovian discusses the importance of patient involvement and education in weight management in T2D in the following video.

Patient involvement in weight management

Patient involvement is crucial in weight management for T2D. Here are several ways patients can be involved41,42:

  1. Education: Patients should be educated on the importance of healthy eating habits, portion control and physical activity
  2. Goal setting: In consultation with their healthcare professional (HCP), patients can set realistic weight loss goals
  3. Healthy eating: Patients can improve their diet by limiting processed foods, sugar and saturated fats, as well as eating a healthy, balanced diet that is low in calories and high in nutrients, such as wholegrains, fruits and vegetables
  4. Physical activity: Patients should avoid sedentary behaviour and instead engage in regular physical activity, such as brisk walking, to aid in weight loss and overall health
  5. Maintain a healthy weight: Losing 1–2 pounds per week gradually can help with glucose control
  6. Collaboration: Patients should collaborate with their HCP to develop a customised weight-management plan
  7. Self-monitoring: Patients can track their progress and make adjustments as needed by regularly monitoring their weight and blood sugar levels
  8. Medications: Patients can consult with their HCP to see if medication is required to aid in weight management
  9. Adherence: Patients should consistently adhere to their exercise, diet plans and medication routine as part of their weight management regimen
  10. Support: Patients can seek support from friends, family or support groups to help with weight loss efforts
  11. Reflection: Patients should reflect on their progress and make changes to their plans as needed to achieve their goals

By being actively involved in their weight management, patients can greatly improve their chances of successfully managing T2D.


  1. World Health Organization. ICD-11. Available at Accessed 25 Jan 2023.
  2. Burki T. European Commission classifies obesity as a chronic disease. Lancet Diabetes Endocrinol. 2021;9(7):418.
  3. World Health Organization. Obesity and Overweight. Available at Accessed 25 Jan 2023.
  4. Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):234–
  5. Xie J, Wang M, Long Z, Ning H, Li J, Cao Y, et al. Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019. BMJ. 2022;379:e072385.
  6. Dai H, Alsalhe TA, Chalghaf N, Riccò M, Bragazzi NL, Wu J. The global burden of disease attributable to high body mass index in 195 countries and territories, 1990-2017: an analysis of the Global Burden of Disease Study. PLoS Med. 2020;17(7):e1003198.
  7. Glauber H, Vollmer WM, Nichols GA. A simple model for predicting two-year risk of diabetes development in individuals with prediabetes. Perm J. 2018;22:17–
  8. Johnson JD. On the causal relationships between hyperinsulinaemia, insulin resistance, obesity and dysglycaemia in type 2 diabetes. Diabetologia. 2021;64(10):2138–
  9. Uusitupa M, Khan TA, Viguiliouk E, Kahleova H, Rivellese AA, Hermansen K, et al. Prevention of type 2 diabetes by lifestyle changes: a systematic review and meta-analysis. Nutrients. 2019;11(11):2611.
  10. Penn L, White M, Lindström J, den Boer AT, Blaak E, Eriksson JG, et al. Importance of weight loss maintenance and risk prediction in the prevention of type 2 diabetes: analysis of European Diabetes Prevention Study RCT. PLoS One. 2013;8(2):e57143.
  11. American Diabetes Association. 3. Prevention or delay of type 2 diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021;44(Suppl 1):S34–S39
  12. National Institute for Health and Care Excellence. Type 2 diabetes: prevention in people at high risk. London: NICE, 2012. Available at Accessed 25 Jan 2023.
  13. Guess ND. Dietary Interventions for the prevention of type 2 diabetes in high-risk groups: current state of evidence and future research needs. Nutrients. 2018;10(9):1245.
  14. Rintamäki R, Rautio N, Peltonen M, Jokelainen J, Keinänen-Kiukaanniemi S, Oksa H, et al. Long-term outcomes of lifestyle intervention to prevent type 2 diabetes in people at high risk in primary health care. Prim Care Diabetes. 2021;15(3):444–450
  15. Feldman AL, Griffin SJ, Ahern AL, Long GH, Weinehall L, Fhärm E, et al. Impact of weight maintenance and loss on diabetes risk and burden: a population-based study in 33,184 participants. BMC Public Health. 2017;17:170.
  16. Centers for Disease Control and Prevention. National Diabetes Prevention Program. Available at Accessed 25 Jan 2023.
  17. Dambha-Miller H, Day AJ, Strelitz J, Irving G, Griffin SJ. Behaviour change, weight loss and remission of type 2 diabetes: a community-based prospective cohort study. Diabet Med. 2020;37(4):681–
  18. Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344–
  19. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of care in diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S128–
  20. Brenk-Franz K, Strauß B, Tiesler F, Fleischhauer C, Schneider N, Gensichen J. Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions. J Psychosom Res. 2017;97:131–
  21. Williams JS, Walker RJ, Smalls BL, Hill R, Egede LE. Patient-centered care, glycemic control, diabetes self-care, and quality of life in adults with type 2 diabetes. Diabetes Technol Ther. 2016;18(10):644–
  22. Parker MM, Fernández A, Moffet HH, Grant RW, Torreblanca A, Karter AJ. Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes. JAMA Intern Med. 2017;177(3):380–
  23. American Diabetes Association. 3. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S28–
  24. International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104(1):1–
  25. Stenov V, Wind G, Vallis M, Reventlow S, Folmann Hempler N. Group-based, person-centered diabetes self-management education: healthcare professionals’ implementation of new approaches. BMC Health Serv Res. 2019;19:368.
  26. Paiva D, Abreu L, Azevedo A, Silva S. Patient-centered communication in type 2 diabetes: the facilitating and constraining factors in clinical encounters. Health Serv Res. 2019;54(3):623–
  27. The National Health Service England. Language matters: language and diabetes. June 2018. Available at Accessed 25 Jan 2023.
  28. Ingrasciotta Y, Bertuccio MP, Crisafulli S, Ientile V, Muscianisi M, L'Abbate L, et al. Real world use of antidiabetic drugs in the years 2011-2017: a population-based study from southern Italy. Int J Environ Res Public Health. 2020;17(24):9514.
  29. Lazzaroni E, Ben Nasr M, Loretelli C, Pastore I, Plebani L, Lunati ME, et al. Anti-diabetic drugs and weight loss in patients with type 2 diabetes. Pharmacol Res. 2021;171:105782.
  30. Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, et al. 2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care. Prim Care Diabetes. 2022;16(2):223–
  31. Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, et al. Management of hyperglycemia in type 2 diabetes, 2022. a consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753–
  32. Htike ZZ, Zaccardi F, Papamargaritis D, Webb DR, Khunti K, Davies MJ. Efficacy and safety of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a systematic review and mixed-treatment comparison analysis. Diabetes Obes Metab. 2017;19(4):524–
  33. GRADE Study Research Group; Nathan DM, Lachin JM, Balasubramanyam A, Burch HB, Buse JB, et al. Glycemia reduction in type 2 diabetes - glycemic outcomes. N Engl J Med. 2022;387(12):1063–
  34. Vosoughi K, Atieh J, Khanna L, Khoshbin K, Prokop LJ, Davitkov P, et al. Association of glucagon-like peptide 1 analogs and agonists administered for obesity with weight loss and adverse events: a systematic review and network meta-analysis. EClinicalMedicine. 2021;42:101213.
  35. White GE, Shu I, Rometo D, Arnold J, Korytkowski M, Luo J. Real-world weight-loss effectiveness of glucagon-like peptide-1 agonists among patients with type 2 diabetes: a retrospective cohort study. Obesity (Silver Spring). 2023;31(2):537–
  36. Weiss T, Yang L, Carr RD, Pal S, Sawhney B, Boggs R, et al. Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK. BMJ Open Diabetes Res Care. 2022;10(1):e002517.
  37. Karagiannis T, Avgerinos I, Liakos A, Del Prato S, Matthews DR, Tsapas A, et al. Management of type 2 diabetes with the dual GIP/GLP-1 receptor agonist tirzepatide: a systematic review and meta-analysis. Diabetologia. 2022;65(8):1251–
  38. Gilbert MP, Pratley RE. GLP-1 analogs and DPP-4 inhibitors in type 2 diabetes therapy: review of head-to-head clinical trials. Front Endocrinol (Lausanne). 2020;11:178.
  39. Cheong AJY, Teo YN, Teo YH, Syn NL, Ong HT, Ting AZH, et al. SGLT inhibitors on weight and body mass: a meta-analysis of 116 randomized-controlled trials. Obesity (Silver Spring). 2022;30:117–128.
  40. Li C, Luo J, Jiang M, Wang K. The efficacy and safety of the combination therapy with GLP-1 receptor agonists and SGLT-2 inhibitors in type 2 diabetes mellitus: a systematic review and meta-analysis. Front Pharmacol. 2022;13:838277.
  41. American Diabetes Association. Type 2 diabetes overview. Available at Accessed 26 Jan 2023.
  42. National Institute of Diabetes and Digestive and Kidney Diseases. Preventing type 2 diabetes. Available at Accessed 26 Jan 2023.