Incretin-based therapies, such as GLP-1s and GIPs, have transformed treatment for people with Type II Diabetes (T2D) and obesity. In turn, many clinicians have harnessed these medications to help patients achieve greater weight loss and improved glycemic control. As GLP-1/GIP use continues to rise, UI Health Care Endocrinologist Kathleen Robinson, MD, PhD, wanted to examine whether medical consultations affect treatment outcomes for patients undergoing incretin therapy. In a recent publication in Obesity Science and Practice, Robinson compared A1C, weight, and low-density lipoprotein (LDL) cholesterol among UI Health Care patients prescribed incretin therapy, with particular attention to their engagement in medical consultations.

The project grouped subjects according to the care they received during the study period. Authors categorized those who visited the Weight Management clinic at least once, in addition to receiving standard diabetes care, as the DM + WM group; those who received diabetes care only were categorized as the DM group.

The study found that people in both groups experienced significant weight loss and improvements in hemoglobin A1c and LDL cholesterol levels over five years. However, people who attended at least 4 weight management visits achieved greater weight loss. Meanwhile, those who attended only one weight management consultation experienced less weight loss than those who received standard diabetes care alone.

Based on the data that emerged from her study, Robinson “tentatively concludes” that attending more weight management visits is an important component of successful weight management.

Weight management v. diabetes care: what’s the difference?
Diabetes care and management—whether obtained through Endocrinology, Primary Care, or Internal Medicine—can help people with diabetes improve glycemic control and address comorbidities such as diabetic retinopathy.

While emphasizing the benefits of diabetes consultations, Robinson notes that it is challenging for clinicians to cover the full range of topics most beneficial to people struggling with T2D and weight loss.

“The American Diabetes Association recommends addressing weight for patients with diabetes, but there are so many things to manage in those visits that it becomes very difficult to have a detailed conversation about lifestyle changes, and weight in and of itself,” Robinson said. “Patients who have supportive care from a diabetes provider see benefits, but having a separate weight management specialist can help them dig into the weight management side of their diabetes. In weight management, we use different strategies to address lifestyle change.”

Weight management specialists provide thorough consults on dietary tracking, physical activity, and weight loss medications to help patients make sustainable lifestyle modifications. They also track weight over time to facilitate more in-depth conversations about someone’s individual needs. In certain cases, this may involve referrals to mental health providers, allowing patients to address disordered eating and other facets of social-emotional wellbeing that can contribute to weight-related concerns.

A case for dual care
UI Health Care Endocrinologist Marcelo Correia, MD, MSc, PhD, a contributor to the study, said that this paper serves as a starting point for a broader conversation about how health systems can use limited resources more effectively.

Correia suggested that weight management care may be particularly beneficial for people with clinical obesity—those with more weight-related complications. A newer distinction between preclinical and clinical obesity defines preclinical obesity as excess adiposity without current impairment of tissues and organs, accompanied by a generally increased risk of progression to clinical disease. In this framework, clinical obesity extends beyond BMI and is defined as a chronic, systematic disease characterized by impairments in the tissues, organs, and daily activities.

Correia noted that weight management specialists are especially well equipped to prescribe incretin-based treatments when accounting for comorbid conditions. This is because these specialists have a comprehensive understanding of the specific indications for GLP-1 and GIP medications used to treat obesity-related complications.

“One example would be for a patient with obesity, diabetes, and coronary artery disease,” Correia said. “This is a common patient, and this patient may benefit from a weight management clinic because they will likely benefit from weight loss. And secondly, we can use data from clinical trials to recommend specific medications for weight management and diabetes in patients with coronary artery disease. For example, semaglutide has an indicator for this specific case.”

Robinson echoed Correia’s sentiment, noting that clinicians specializing in weight management remain closely attuned to new publications on incretin therapy indicators, given their frequent role in helping people access treatments best suited to their comorbidities. The specialty also stays current with the evolving medication pricing and availability.

Whether accessed through standard diabetes care or weight management services, both Correia and Robinson emphasize that incretin therapies can open the door to additional interventions by helping address barriers to sustaining lifestyle modifications. For example, a person prescribed a GLP-1 or GIP may be better able to optimize their weight for surgery if their current weight limits access to procedures intended to alleviate hip or knee pain. With targeted weight loss treatment, these individuals can plan for future operations that might make physical activity more feasible.

Looking ahead
As more patients at UI Health Care gain access to GLP-1s, Robinson hopes to continue studying the longer-term outcomes of incretin-based treatments.

“I think we’re in a really exciting era for weight management and weight management providers,” Robinson said. “It’s not just about weight; it’s really about the metabolic health outcomes and helping people achieve the health that they’re looking for. I’ve been grateful to be a part of this team.”