Endocrine Abstracts

Weight loss in individuals with Obesity (O) and Type 2 Diabetes (T2D), may improve glycaemic control and weight-related comorbidities, and in some cases, induce diabetes remission. However, body weight control is generally an unmet aim in this population. Thus, there is an increasing need to consider pharmacological approaches to assist weight loss in diabetes-obesity. Glucose-lowering agents as the sodium-glucose co-Transporter 2 inhibitors (SGLT2i) and GLP-1 Receptor Agonist (GLP1-RAs) have been proved to be capable to simultaneously control body weight and glucose levels, and their use has been recommended in individuals with O and T2D. Recently, we demonstrated the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) in inducing weight loss up to 1 year in O individuals with and without T2D.

Aim of this study was to compare retrospectively the efficacy of SGLT2i, GLP1-RAs and rTMS in long-term (up to 1 year) body weight reduction in patients with O and T2D. Data obtained from 31 patients with O and T2D were retrospectively analysed: 11 subjects (bw 98.1±18.3 Kg, BMI 36.8±5.7 Kg/m2) were treated for O with High Frequency rTMS for 5 weeks, 8 subjects (93.4±13.1 Kg, 33.6±3.1 Kg/m2) were treated for T2D with SGLT2i for 1 year, and 12 individuals (98.1±18.3 Kg, 36.8±5.7 Kg/m2) were treated for T2D with GLP1-RA for 1 year. Data relating to bw, BMI, glucose, glycated hemoglobin, cholesterol and triglycerides variations in the 3 groups have been analyzed with ANOVA, after 6 months (FU1) and 1 year (FU2) from the start of treatment. Body weight variation (%) between the 3 groups was significant both at F1 [-3.2±1.8% (SGLT2i) vs -3.5%±1.5% (GLP1-RA) vs -6.3±4.0% (rTMS);P=0.026] and FU2 [-2.1±2.1% (SGLT2i) vs -2.1±4.2% (GLP1-RA) vs −6.7±4.7% (rTMS);P=0.017]. As expected, glycated hemoglobin variation was significantly higher in SGLT2i and GLP-1 RA groups both at FU1 [-11.7±25.1% (SGLT2i) vs -11.9%±13.2% (GLP1-RA) vs -8.9±10.4% (rTMS);P=0.922] and FU2 [-15.9±24.2% (SGLT2i) vs -7.8±11.9% (GLP1-RA) vs -5.6±9.0% (rTMS);P=0.116], although not statistically significant. In this study, rTMS revealed to be a more effective intervention than SGLT2i and GLP1-RAs in promoting long-term weight loss in a population with O and T2D, probably due to a prevalent effect of rTMS on controlling food craving and appetite at the level of meso-cortico-limbic system. These findings lay groundwork for a potential use of dTMS as an add-on intervention for the treatment of T2D and O.