The impact of pharmacological and lifestyle interventions on body weight in people with type 1 diabetes: A systematic review and meta‐analysis.

Aim: To systematically review the effects of pharmacological and lifestyle interventions on body weight as a secondary outcome in people with type 1 diabetes. Methods: The Ovid Medline, Embase and Cochrane Library databases were searched for relevant pharmacological (glucagon‐like peptide‐1 [GLP‐1] receptor agonist, sodium‐glucose co‐transporter‐2 [SGLT‐2] inhibitor, dipeptidyl peptidase‐4 [DPP‐4] inhibitor and metformin) and lifestyle intervention studies (diet and exercise) for adults with type 1 diabetes reporting body weight change and HbA1c published from January 2000 to May 2020. Meta‐analyses were performed for 16 randomized controlled trials (RCTs). Results: Thirty‐three RCTs (n = 9344 participants), 26 pharmacological (on average 43.9 years, 83.1 kg, HbA1c 8.1%; 55.8% male) and seven lifestyle‐based interventions (on average 37.0 years, 85.0 kg, HbA1c 8.1%; 84.6% male), were analysed. The GLP‐1 receptor agonist liraglutide 0.6 mg (mean difference [MD]: –2.22 kg [95% CI: –2.55 to –1.90]), 1.2 mg (MD: –3.74 kg [95% CI: –4.16 to –3.33]) and 1.8 mg (MD: –4.85 kg [95% CI: –5.29 to –4.41]), and the SGLT‐2 inhibitors empagliflozin 2.5 mg (MD: –1.47 kg [95% CI: –2.23 to –0.71]), 10 mg (MD: –2.77 kg [95% CI: –3.24 to –2.31]) and 25 mg (MD: –3.06 kg [95% CI: –3.57 to –2.55]) and sotagliflozin 200 mg (MD: –2.40 kg [95% CI: –2.87 to –1.94]) and 400 mg (MD: –3.23 [95% CI: –3.73 to –2.72]) were associated with significant reductions in body weight. No significant effect on body weight was found for DPP‐4 inhibitors, other GLP‐1‐receptor agonists, metformin, or for lifestyle interventions (i.e. exercise and diet). Conclusions: In people with type 1 diabetes, several adjuvant pharmacological interventions showed weight reduction as a secondary outcome. Future studies in overweight people with type 1 diabetes are needed to establish whether the lifestyle and pharmacological interventions reviewed here have potential as components of complex interventions aimed at body weight reduction as a primary outcome. [ABSTRACT FROM AUTHOR]