Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done?
Open accessAbstract
Insulin therapy ( IT ) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT , which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin‐associated weight gain ( IAWG ) is reported to occur in the first year of initiating IT , predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch‐up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co‐morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT , that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG , and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.
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Possible reasons for smaller weight reductions in diabetes include lower resting metabolic rate after better glycemic control, poorer dietary adherence and defensive snacking from hypoglycemia fear, and less glycosuria.
“Mechanisms responsible for smaller weight losses in patients with diabetes may include reductions in resting metabolic rate, which occur with improved glycemic control (accompanying weight loss), decreased dietary adherence and “defensive snacking” related to fears of hypoglycemia, as well as reduced glycosuria.(49, 50)”
From Semaglutide for the treatment of obesity (2023) · cites this paper as [50]
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- Authors
- Brown, A., Guess, N., Dornhorst, A., Taheri, S., & Frost, G.
- Affiliations
- Imperial College London (GB)
- King's College London (GB)
- Weill Cornell Medical College in Qatar (QA)
- Corresponding author
- Brown, Adrian
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2017-07-13
- Volume
- 19
- Issue
- 12
- Pages
- 1655-1668
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2614402130
- Cited by
- 113
- References
- 173
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 10 · 2023: 14 · 2022: 17 · 2021: 18 · 2020: 22 · 2019: 8 · 2018: 5 · 2017: 2
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Qatar National Research Fund (NPRP 8-912-3-192)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, obesity, insulin therapy, insulin intensification, adipose tissue, energy intake, fear of hypoglycemia, glycosuria, catch-up growth, appetite regulation, predictors of weight gain, weight management strategies, glycemic control
- MeSH terms
- Healthy Lifestyle, Animals, Appetite Regulation, Energy Intake, Combined Modality Therapy, Diabetes Mellitus, Type 2, Diet, Diabetic, Diet, Reducing, Humans, Hypoglycemic Agents, Insulin, Obesity, Weight Gain, Exercise, Drug Monitoring, Adiposity
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