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Case study

Case report: GLP-1R results in effective weight loss

After 14 months of treatment her HbA1c level was reduced to 5.5% and reduced her body weight by 21.2kg

Glucagon-like peptide-1 receptor (GLP-1R) agonists could be an important therapeutic aid in conjunction with diet control and lifestyle modifications for morbidly obese, T2DM patients who are preparing to have bariatric surgery, according to a paper from Taiwan entitled, ‘Effective weight loss after treatment with a glucagon-like peptide-1 receptor agonist in a morbidly obese and diabetic patient before bariatric surgery: a case report’, published in in The Journal of Medical Case Reports.

GLP-1R agonists are a new class of anti-diabetic drugs and are widely used in the treatment of type 2 diabetes. As previously reported by, GLP-1R has been used in in conjunction with a laparoscopic adjustable gastric banding in rats to demonstrate weight loss. However, this case report claims that the effect of GLP-1R agonists on the treatment of preoperative weight loss in obese type 2 diabetic patients has not been reported.

Case report

A 38-year-old, morbidly obese, type 2 diabetic Taiwanese woman with more than five years history of hypertension, weighed 170kg (BMI 69.9), and her fasting glucose level was 132mg/dl. Although she was recommended for bariatric surgery, due to the high risk of complications associated with surgery, she was prescribed diet control with lifestyle modifications and pharmacological treatment for weight loss to reduce the chance of surgical complications.

Dietitians recommended a high fibre diabetic full diet with a calorie restriction of 1800kcal/day, as well as pharmacological treatment with metformin (1g/day) and a GLP-1 receptor agonist (exenatide 20mg/day via subcutaneous injection).

The patient reported poor compliance of exenatide at a twice daily usage, so was subsequently placed on liraglutide (1.2mg/day via subcutaneous injection). After 14 months of treatment her HbA1c level was reduced to 5.5% and reduced her body weight by 21.2kg (Figure 1). She reported no problems with gastrointestinal distress or hypoglycemia and noted a slight decrease in appetite. She is currently under regular GS outpatient clinic follow-up and bariatric surgery has been arranged.

Figure 1: Course of treatment graph showing the corresponding effect on weight and HbA1c level. The duration of treatment with diet control, lifestyle modifications and pharmacological agents are represented by the length of each box relative to the time period on the x-axis. Changes in HbA1c are shown by the black circle line plotted against the y-axis (right), and changes in weight are shown by the blue rhombus line plotted against the y-axis (left). Significant improvement in glycemic control and sustained weight loss after metformin and exenatide is shown.

“To the best of our knowledge, this is the first clinical evidence supporting the use of GLP-1 receptor agonists on the treatment of preoperative weight loss in obese type 2 diabetic patients,” write the researchers from Tri-Service General Hospital Taipei, Taiwan. “Therefore, in addition to diet control and lifestyle modifications, GLP-1 receptor agonists would appear to be an important therapeutic option in a morbidly obese patient with type 2 diabetes before undergoing bariatric surgery. Randomised controlled clinical trials of GLP-1 receptor agonists as preoperative weight-reducing agents in severely obese patients with type 2 diabetes are warranted.”

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