Management of Type 2 Diabetes Mellitus with Overweight: Focus on SGLT-2 Inhibitors and GLP-1 Receptor Agonists

GLP-1 receptor agonists (GLP-1RAs) and SGLT-2 inhibitors, along with the widely used metformin, are the drug classes discussed in this mini-review. GLP-1RAs stimulate insulin secretion and slow down gastric emptying, thereby contributing to weight loss. SGLT-2 inhibitors lessen renal glucose reabsorption, lower blood pressure, and contribute to body weight reduction. A similar effect on body weight should be anticipated from the intestinal alpha-glucosidase inhibitor (acarbose), but its efficiency depends on the carbohydrate contents of diet. Notably, the hypoglycemic effects of the two drug classes are unrelated to the stimulation of insulin secretion by beta cells. An exhaustion of beta cells as a result of a prolonged stimulation is regarded as possible. Insulin hypersecretion contributes to an increase in body weight. This indicates that, other things being equal, drugs acting without the stimulation of insulin secretion may be preferable. In conclusion, the goals of glycemic control need to be individualized based on age, prognosis, the presence of macrovascular disease, and the risk of hypoglycemia.

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