Endocrine Abstracts

The importance of weight reduction in the management of diabesity is well-established. However, significant weight loss can be difficult to achieve without bariatric surgery, even within specialist tier 3 obesity services. Here we describe the case of a 52 year old man who presented to weight management clinic. He had made multiple weight loss attempts, but with little success. On presentation, his weight was 140.8 kg with a BMI of 40.3 kg/m2, and he had now been static at this weight for approximately 10 years, despite best efforts.

He began management under the weight management team (dietetics, psychology, medical team), and was considering weight loss surgery. He qualified for this with his BMI and weight, but also had a diagnosis of type 2 diabetes mellitus (T2D) diagnosed 6 years previously. He was taking metformin 500 mg TDS and sitagliptin 100 mg OD, with a poorly-controlled HbA1c of 84.

The SGLT-2 inhibitor dapagliflozin was initiated, and he was for medical review in 6 months with dietetics input in the interim. He lost weight consistently, and motivation/lifestyle change increased as a result. At 6 month review he weighed 107.8 kg (a 33kg loss), and BMI was 33.5 kg/m2 (down from 43.3 kg/m2). His HbA1c had halved, at 43 mmol/mol.

He now had excellent glycaemic control, and a reduced weight such that he no longer required weight loss surgery.

This case highlights some important learning points:

1. SGLT-2 inhibitors in the context of diabesity can effect significant weight loss and improved glycaemic control.

2. It highlights the importance of pharmaceutical and lifestyle management of diabesity in the first instance as some patients do extremely well, no longer requiring surgery.

3. In this case, the pharmaceutical agent and weight management team support acted synergistically to effect weight loss where motivation alone had failed for some years.