We retrospectively studied the effect on BMI and metabolic control (HbA1c within therapeutic targets) of structured lifestyle intervention associated with glucagon-like-1 receptor agonists (GLP-1RA) compared to GLP-1RA alone in patients with Type 2 diabetes (T2DM).
Materials and method: The anthropometric and clinical data of 525 T2DM patients who started therapy with GLP-1RA were collected in a comprehensive database with follow-up of 24 months. According to our protocol, behavior therapy is offered to all cases first attending our institution. Behavioral treatments were carried out within 6 months of GLP-1RA treatment and were classified either as elementary nutrition education (ENE, 5 group sessions) or as cognitive-behavior treatment (CBT, 12 group sessions). The primary endpoint was weight loss (≥5% initial body weight); secondary endpoint was A1c target achievement (≤7%). Patients with out at least 12 months follow up, who changed T2DM drug treatment or interrupted GLP-1RA treatment were excluded from the analysis. In total, 255 (146 male) patients were selected, 191 only received GLP-1RA treatment and 64 accepted either ENE (n=21) or CBT (n=43).
Results: Body weight decreased significantly in all groups in the course of the 2-yr follow-up (P < 0.001). Mean weight loss was 6.5, 5.2 and 3.1% for CBT, ENE and GLP-1RA alone at 1-year, respectively, and increased to 8.3, 6.7 and 3.3% at 2-year follow-up. At logistic regression analysis the participation into a CBT program increased the probability of both 5 and 10% weight loss at 12 months (OR 2.67; 95% CI, 1.205.95 and OR 7.62; 95% CI 2.7720.95, respectively), after correction for age and gender. The results on 5 and 10% weight loss were maintained at 2 years (OR 5.91; 1.8418.97 and OR 4,99; 1.1920.96). HbA1c decreased in all groups, more significantly in the CBT group (−1.39% vs −0.87 in GLP-1RA alone at 12 months; P=0.045; −1.09% vs −0.85 at 24 months).
Conclusions: The results indicate that intensive lifestyle intervention exerts a significant effect on both body weight and metabolic control in subjects initiating a GLP-1RA treatment. Lifestyle- and GLP-1RA-associated weight loss are likely to produce mutual reinforcement.