Table 2.

Type 2 diabetes mellitus mediations and their overall weight effect

Drug	Mechanism of action	Weight effect
Medications with a weight neutral or weight loss effect
Alpha-glucosidase inhibitors (acarbose)	Delays breakdown of polysaccharides by blocking gut enzymes and decreasing postprandial glucose spike	0 kg to –0.2 kg
Biguanides (metformin)	Improves peripheral insulin resistance and normalises hepatic glucose output	0 kg to –3.8 kg
DDP-4 inhibitors	Inhibits DPP4, the enzyme which inactivates GLP-1, thereby extending the metabolic effects of GLP-1	0 kg to –0.4 kg
GLP-1 agonists	Acts as GLP-1 mimetic. GLP1: stimulates insulin production from beta-cells regulates glucagon secretion slows gastric emptying provides feeling of satiety	–1.3 kg to –7.2 kg
SGLT2 inhibitors	Inhibits glucose reabsorption in proximal tubule of the kidney and cause excess urinary glucose excretion; note risk of euglycaemic diabetic ketoacidosis	–1.5 kg to –2.4 kg
Medications with a weight gain effect
Insulin analogues, isophane insulin or animal insulin	Perform the same as human insulin	+3.9 kg to +5.0 kg
Sulphonylurea	Acts as an insulin secretagogue on receptors within beta-cells, increasing insulin secretion	+1.6 kg to +2.6 kg
Thiazolidinediones	Activates PPAR-G receptors to decrease insulin resistance and increase glucose uptake in cells Activating of PPAR-G cells on adipocytes can stimulate adipogenesis	+4.2 kg to +4.8 kg

GLP-1 = glucagon-like peptide-1; PPAR-G = peroxisome proliferator-activated receptor gamma; SGLT2 = sodium-glucose cotransporter-2.