Diabetes continues to be a growing health problem in the United States. In fact, in the US,the percentage of people with type 1 or type 2 diabetes now stands at almost 11.3% (and those with type 2 diabetes account for 90-95% of those with diabetes). If we include pre-diabetics, it adds an estimated 84.1 million people (or 1 in 3 Americans).

In 2021, The National Clinical Care Commission, in its report to Congress, named diabetes mellitus a ‘national health crisis.’ ^[1] The distinction is not new, however. Obesity, a precursor to type 2 diabetes, stands out as a decades-long crisis. It is further reported that approximately 80% of all type 2 diabetes mellitus (T2DM) cases are linked to obesity. ^[2]

A chronic, debilitating, and even fatal condition, T2DM requires blood sugar monitoring and treatment. A case can be made for weight loss in people with pre-diabetes; losing weight can delay the onset of the disease.

People with T2DM either don’t produce enough insulin, or they don’t properly use insulin, the hormone that metabolizes sugar in our body’s cells. The result is insulin resistance and high blood sugar.

Effects of high blood sugar and insulin resistance

Excess sugar in the blood is associated with health-related complications. That’s because the body’s cells can’t get the sugar they need, possibly resulting in:

• damage to blood vessels and nerves, mostly in the heart, eyes, kidneys, feet and hands,
• complications that include heart disease, possibly leading to stroke,
• nerve damage that can cause hand, leg and foot problems,
• renal impairment that can result in kidney failure

Overall, T2DM can lead to erectile dysfunction and/or loss of desire, even depression. Excess weight may worsen these complications.

Excess weight and exercise/diet

Excess weight harms health, especially for people with T2DM.

When people with T2DM exercise, their muscles utilize excess sugar from the blood. This helps lower complications, insulin resistance, and even lowers weight.

Not all people with T2DM are able to commit to a program of regular exercise to improve weight and lower health risks.

But we can choose foods that are rich in nutrients. Fruits and vegetables, and foods rich in complex carbohydrates—brown rice, oatmeal, quinoa, and beans, lean meat, and fish are great examples. There are plenty of free meal planning guides, too: see

• American Diabetes Association Quick Meal Ideas
• The CDC’s Plate Method
• Klinio (by Diabetes Strong) is a free to downloadable app that offers diet planning and helps us keep track of progress. Membership and books do cost, however. Even without membership, this is a very handy app!

When type 2 medications can help

Daily exercise and an improved diet aren’t a cure for diabetes. There’s no cure. But T2DM can be treated and controlled. People with T2DM often turn to medication to find better glycemic control. Like exercise and diet, medication can provide many benefits—most important among them—lowering high levels of sugar in blood.

Medication may help shed weight.

The International Journal of Clinical Practice reported, “Weight loss is considered key to management of T2DM because of the potential to reduce blood glucose; however, weight loss can also impact other health problems commonly associated with T2DM.” ^[3]

The other health problems weight loss may improve:

• quality of life,
• improved mobility,
• glycemic control,
• reduction in the risk of cardiovascular events (like stroke and heart attack),
• lowered blood pressure,
• plaque reduction in arteries,
• improved insulin resistance,
• and decreased inflammatory responses in the muscles.

Obesity was long thought to be attributed to lifestyle choices. Medical professionals now understand that obesity is a medical condition. Losing weight is hard to do, but with support—in the form of medication and/or lifestyle changes that can include exercise and diet—people with T2DM can enjoy a host of benefits.

Medications that can help with weight loss for T2DM patients

There are several FDA approved medications, most of which reduce the complications of T2DM. The medications help shed pounds, too. Let’s compare them, and we’ll consider their efficacies, how they benefit people with T2DM.

GLP-1 Receptor Agonists

• Trulicity (dulaglutide)
• Saxenda (liraglutide)
• Ozempic (semaglutide)
• Wegovy(semaglutide)
• Rybelsus(semaglutide)

These FDA-approved medications are classified as GLP-1 (glucagon-like peptide) receptor agonists. Trulicity is manufactured by Eli Lilly, Ozempic, Rybelsus and Wegovy are manufactured by Novo Nordisk. None contain insulin, but—like insulin—they are taken by injection.

GLP-1 COMPARISON

Medication	Trulicity	Saxenda	Wegovy	Ozempic	Rybelsus
Type of GLP-1	Dulaglutide	Liraglutide	Semaglutide	Semaglutide	Semaglutide
(Dosing) Strengths Available	0.75 mg/ up to 4.5 mg Injectable pen	0.6 mg/ up to 3.0 mg Injectable pen	0.25 mg/ up to 2.4 mg           Injectable pen	0.5 mg/ up to 2.0 mg Injectable pen	Adults: 3 mg up to 14 mg. Children: determined by doctor   Tablet (oral)
Used to Treat	T2DM high glucose (AIC) levels in adults, Cardiovascular risk reduction, weight loss	Weight loss for adults	Weight loss for adults	T2DM high glucose (AIC) levels in adults, Cardiovascular risk reduction, weight loss	T2DM high glucose (AIC) levels in adults and children, possible weight loss
Side-effects	Belly pain, nausea, vomiting, diarrhea, constipation, decreased appetite, fatigue, malaise, bloating, belching, and gastroesophageal reflux disease	Nausea, vomiting, stomach upset, diarrhea, gas, heartburn, constipation	Stomach pain Constipation Diarrhea Dyspepsia, abdominal distension, eructation Fatigue Flatulence, gastroenteritis, gastroesophageal reflux disease, headache, dizziness hypoglycemia (low blood sugar) in patients T2DM	Belly pain, nausea, vomiting, diarrhea, constipation	Anxiety, bloating, blurred vision, chills, cold sweats, confusion, constipation, cool, pale skin, cough, dark urine, depression, diarrhea, difficulty swallowing, dizziness, fast heartbeat, fever, headache, increased hunger, indigestion, large, hive-like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, sex organs, loss of appetite, nausea, nervousness, nightmare, stomach/abdomen pain, seizures, skin rash, slurred speech, chest tightness, trouble breathing, unusual tiredness/weakness Vomiting Yellow eyes or skin
Efficacy for Weight Loss	Up to 10 pounds over time at highest strength	Average 10% body fat = 200 pound person can lose 20 lbs	Greater than 5%, up to 15% over 68 weeks at highest strength	10%, and up to 15%, up to 13 pounds over 26 weeks at highest strength	Average 3 pounds for adults avg. weight of 195 lbs

One of the newestdiabetes medications added to the T2DM fleet is Mounjaro, (Eli Lilly & Company). Mounjaro was FDA approved May 13, 2022 as a treatment for adults with type 2 diabetes. Mounjaro is a dual GLP-1 and GIP agonist. While approved only for people with T2DM, Mounjaro offers promising efficacy for weight loss.

Study participants treated with Mounjaro lost between 12 lb. (5 mg) and 25 lb. (15 mg) on average.^[4] Those taking the highest strength experienced greatest weight loss.

Knowing that there’s medications available to control T2DM and help with weight loss is great news. When possible, discuss the many choices with your healthcare provider or endocrinologist. Talk about the possibility of adopting an active lifestyle and healthy eating habits, too.

We want to achieve our best health for our personal happiness. Don’t forget, friends and loved ones want our healthiest selves, too. We may find that over time, our better health brings more time to sail through life with greater ease.

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^[1]National Clinical Care Report to Congress

^[2]Aras M, Tchang BG, Pape J. Obesity and Diabetes

^[3]Wilding, J.P.H. The importance of weight management in type 2 diabetes mellitus.PMCID: PMC4238418PMID: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238418/

^[4]https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-mounjarotm-tirzepatide-injection-first-and