Diabetes severity, as assessed by the individualised metabolic surgery (IMS), can help predict the weight loss outcomes achieved by semaglutide in patients with diabetes, according to a study led by researchers from the Mayo Clinic, Rochester, MN. They noted that the application of this score could permit a personalised approach for selection of anti-obesity medications (AOMs) and help define realistic goals in terms of weight loss.
The IMS score has been validated to predict T2DM remission after bariatric surgery. The parameters of the IMS are HbA1c (<7%), insulin use, T2D medications and T2D duration. For this study, the authors sought to assess weight loss outcomes of semaglutide based on IMS score in patients living with obesity and T2DM.
This retrospective multi-centred cohort study included patients with T2DM and BMI≥27kg/m2 taking ≥1mg of semaglutide recruited from January 2020 to December 2022. Patients with a history of bariatric surgery or taking other anti-obesity medications were excluded. IMS was calculated at baseline and patients weight change was recorded at baseline, three, six, nine and 12 months. IMS was classified as mild (0–24.9 points), moderate (25–94.9 points), and severe (95–180 points). They performed mixed linear regression models including age, sex, and baseline weight to assess associations between IMS categories with total body weight loss percentage (TBWL%).
In total, 297 patients (42% female, mean age 62 ± 12 years) were included in the analysis. At 12 months, there was a stepwise decrease in weight loss outcomes when comparing patients by IMS quartiles (LS mean TBWL%± SE): 8.8 ± 0.8% vs 6.9 ± 0.8% vs 5.7 ± 0.9% vs 5.0 ± 0.8%. In the mixed linear model, patients in the mild-moderate category achieved significantly superior weight loss outcomes (LS mean TBWL± SE: −8.3 ± 0.7%) than patients in the severe category (−5.5 ± 0.6%; difference: −2.9, 95% CI: −5.2 to −0.5, p=0.006) at 12 months. There was no significant difference in glycaemic improvement regardless of IMS severity at baseline.
“Our findings could help clinicians set informed expectations for weight loss outcomes in patients with severe T2D taking semaglutide, however, it is likely that the cardiometabolic benefits associated with semaglutide treatment in this population far exceed the effect on weight loss,” the authors concluded. “It is essential to apply this scoring model to previous and future randomized clinical trials to test its efficacy in predicting weight loss outcomes of semaglutide and other glucagon-like peptide-1 receptors agonists. In addition, mechanistic studies are needed to further understand the effect of T2D on weight loss outcomes of semaglutide.”
The findings were featured in the paper, ‘Weight loss outcomes with semaglutide based on diabetes severity using the individualized metabolic surgery score’, published in eClinicalMedicine.
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