Combination of GLP‐1 receptor agonists and behavioural treatment in type 2 diabetes elicits synergistic effects on body weight: A retrospective cohort study

AIMS: Intensification of type 2 diabetes (T2DM) treatment with GLP‐1 receptor agonists (GLP‐1RAs) promotes weight loss. We aimed to determine the synergistic effect of behavioural programmes on body weight on top of GLP‐1RA treatment. MATERIALS AND METHODS: We retrospectively analysed the time course of 328 individuals with T2DM starting GLP‐1RA treatment because of insufficient metabolic control. In 29, a structured programme of elementary nutritional counselling was also implemented (elementary nutritional education [ENE]‐5 group sessions), whereas 53 entered a programme of cognitive‐behavioural treatment (CBT‐12 group sessions). Both programmes were completed within 6 months of switching to GLP‐1RAs. Data of body weight and metabolic control were followed up to 2 years as part of regular follow‐up. Weight loss targets (≥10% and ≥5%) and metabolic target (HbA1c < 7%) were analysed by Cox regression model in comparison with standard care (SC, N = 244). RESULTS: Body weight remarkably decreased following both behavioural programmes, with significant differences compared with SC at 2 years (CBT, 8.5 ± 5.9% vs 6.3 ± 6.9 in ENE and only 3.1 ± 5.7 in SC; P < 0.001 and P = 0.045 vs CBT and ENE, respectively). The 10% weight loss was achieved and maintained in approximately 30% of cases during follow‐up, and an additional 35% of cases lost between 5% and 10%. Data were consistent between behavioural programmes, after adjustment for confounders, including initial body weight (logreg Mantel‐Cox: ENE vs SC, P < 0.01; CBT vs SC, P < 0.001). No differences in metabolic control were detected between groups. CONCLUSIONS: Initiation of GLP‐1RA treatment provides an opportunity for addressing patients' needs of weight control. By producing initial weight loss, patients' motivation and self‐efficacy are expected to increase and adherence to long‐term lifestyle changes might be more easily attained.