The impact of pharmacological and lifestyle interventions on body weight in people with type 1 diabetes: A systematic review and meta-analysis

AIMS: In people with type 1 diabetes the prevalence of excess weight and metabolic syndrome is increasing, but there are no evidence-based weight reduction strategies. We systematically reviewed the effects of interventions on body weight change as a secondary outcome.METHODS: Databases (Ovid Medline, Embase and the Cochrane Library) were searched for relevant pharmacological (GLP-1 receptor agonists, SGLT-2 inhibitors, DPP-4 inhibitors, metformin) and lifestyle intervention studies (Diet and Exercise) for adults with type 1 diabetes reporting body weight change and glycated hemoglobin A1c (HbA1c) published between 1/2000 and 5/2020. Meta-analyses were performed for 16 randomized controlled trials (RCT).RESULTS: Thirty-three RCT (n=9,344), 26 pharmacological (on average 43.9 years, 83.1 kg, HbA1c 8.1%; 55.8% male) and 7 lifestyle-based interventions (on average 37.0 years, 85.0 kg, HbA1c 8.1%; 84.6% male). The GLP-1-receptor-agonist liraglutide 0.6mg (mean difference (MD):-2.22kg[95% CI:-2.55;-1.90]), 1.2mg (MD:-3.74kg[95%CI:-4.16;-3.33]), 1.8mg (MD:-4.85kg[95%CI:-5.29;-4.41]), the SGLT-2 inhibitors empagliflozin 2.5mg (MD:-1.47kg[95%CI:-2.23;-0.71]), 10mg (MD:-2.77kg[95% CI:-3.24;-2.31]), 25mg (MD:-3.06kg[95% CI: -3.57;-2.55]) and sotagliflozin 200mg (MD:-2.40kg[95%CI:-2.87;-1.94]) and 400mg (MD:-3.23[95%CI:-3.73;-2.72]) were associated with significant reductions in body weight. There was no significant effect on body weight for DPP-4 inhibitors, other GLP-1-receptor-agonists, metformin nor for the lifestyle interventions (exercise, diet).CONCLUSIONS: In people with type 1 diabetes, several adjuvant pharmacological interventions showed weight reduction as secondary outcome. Future studies in overweight people with type 1 diabetes mellitus will be needed to establish, whether the lifestyle and pharmacological interventions reviewed here have potential as components of complex interventions aimed at body weight reduction as primary outcome. This article is protected by copyright. All rights reserved.