Case 2
You have a patient with a BMI of 31 kg/m2 who is newly diagnosed with type 2 diabetes. Why should you start that patient with metformin? Why won’t you start with something that will directly tackle obesity and get the patient to lose 20 pounds and for sure the blood sugar is going to be better?
“I think if I have someone who is really keen to put their diabetes into remission,” Dr. Wilding said, “this would be a fantastic approach because they would have a really high chance of doing that.”
The prediabetes data from STEP showed that “we can put a lot of people from prediabetes back to normal glucose tolerance,” Dr. Wilding noted. “Maybe we can put people with early diabetes back to normal as well. I think that’s a trial that really does need to be done,” he said.
“We’re going to have to figure out the best pathway forward,” Dr. Kaplan observed, noting that multiple stakeholders, including payers, patients, and providers, play a role in the uptake of new obesity drugs.
“Do you think we will see less bariatric surgery with these drugs?” Dr. Rosenstock asked Dr. Kaplan.
“I think you have to remember that of the millions and millions of people with obesity, a very small portion are currently treated with antiobesity medication, and an even smaller portion are getting bariatric surgery,” Dr. Kaplan replied.
“In the United States, 90% of people who get bariatric surgery are self-referred,” he said, so, “I think initially we are not going to see much of a change” in rates of bariatric surgery.
Dr. Rosenstock, Dr. Kaplan, Dr. Wilding, and Dr. Davies disclosed ties with Novo Nordisk and numerous other companies.
A version of this article first appeared on Medscape.com.