Which Diabetes Medications Can Cause Weight Loss or Gain

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More than 1 in 10 people in the U.S. are living with diabetes. Diabetes is a condition that happens when your body can't make or use insulin. Without insulin, the body's blood glucose (blood sugar) rises to unsafe levels. The majority of people living with diabetes have Type 2 diabetes.

Some diabetes medications can affect your body weight. This could mean either weight loss or weight gain. But not all diabetes medications cause weight changes. Some have little effect on body weight for most people who take them.

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Which diabetes medications can cause weight loss?

There are five types of diabetes medications that can cause weight loss. These medications each work differently from each other.

1. GLP-1 agonists like Ozempic

Glucagon-like peptide-1 (GLP-1) agonists are a group of medications growing in popularity when it comes to diabetes and weight loss. GLP-1 is a hormone in our bodies that tells our pancreas to release insulin after we eat. It also lowers the amount of new glucose your liver produces. And it helps us feel full in between meals. GLP-1 agonists act like GLP-1 does in the body.

Some studies have shown that people with diabetes lost as much as 14 lbs when using a GLP-1 agonist. Other studies have suggested GLP-1 agonists cause more modest weight loss (about 2 lbs). The amount of weight loss can vary, depending on which medication and what dose is used. Many studies in people with diabetes that looked at weight loss from GLP-1 agonists ran for between 6 and 12 months.

There are several GLP-1 agonists FDA-approved for Type 2 diabetes, including:

• Ozempic (semaglutide)

• Rybelsus (semaglutide)

• Trulicity (dulaglutide)

• Victoza (liraglutide)

Good to know: Two GLP-1 agonists are also approved for chronic weight management: semaglutide (sold as Wegovy) and liraglutide (sold as Saxenda). These medications are administered at higher doses when they're being used for weight loss. And they're not interchangeable with the versions used to treat Type 2 diabetes. Using Ozempic or Victoza for weight loss is an off-label use of the medications.

2. Mounjaro

Mounjaro (tirzepatide) works like GLP-1 agonists - but with an added boost. It acts like GLP-1 and another hormone called glucose-dependent insulinotropic polypeptide (GIP). This dual effect can help provide better blood glucose-lowering effects. It can also lead to greater weight loss than with GLP-1 agonists like Ozempic. In studies, people taking Mounjaro lost an average of 16 lbs to 25 lbs, depending on the dose.

The active ingredient in Mounjaro - tirzepatide - is also approved for weight loss. But it's approved under the brand name Zepbound. Similar to the GLP-1 agonists mentioned above, using Mounjaro for weight loss is an off-label use of the medication. Mounjaro is only approved for Type 2 diabetes.

3. Metformin

Metformin is another diabetes medication that can cause weight loss as a side effect for some people. It's one of the most prescribed diabetes medications because it's effective for lowering blood glucose and has lower-cost generic versions available. It mainly lowers the amount of glucose made and absorbed by the body, and it makes the body more sensitive to its natural insulin.

Metformin's weight loss is more modest than the medications listed above. And not everyone loses weight while taking it. But studies have shown some people may lose up to 6 lbs after taking metformin for a year.

4. SGLT2 inhibitors like Jardiance

Another group of diabetes medications called sodium-glucose cotransporter 2 (SGLT2) inhibitors can cause weight loss. SGLT2 inhibitors remove glucose from the blood through urine. Less glucose in the blood means less glucose is available to be turned into fat cells. And this can lead to modest weight loss for some people. People taking SGLT2 inhibitors may lose about 4 lbs to 6 lbs while taking them.

Examples of SGLT-2 inhibitors include:

• Jardiance (empagliflozin)

• Farxiga (dapagliflozin)

• Invokana (canagliflozin)

5. Symlin

Symlin (pramlintide) is a lab-made form of the hormone amylin. Amylin slows down food movement through the stomach and prevents your liver from making glucose. Symlin acts like amylin does in the body. This medication can cause most people with diabetes to lose up to 4 lbs. For people with diabetes who are also considered obese, they may lose up to 7 lbs with Symlin.

Which diabetes medications can cause weight gain?

There are four main groups of diabetes medications that can cause weight gain. They all work by affecting insulin in the body. And as we'll discuss later, medications that affect insulin levels in your body can cause weight gain.

1. Insulin

Insulin is one of the most commonly used diabetes medications. Most forms of insulin can make people gain weight. People taking insulin for Type 2 diabetes gain an average of 4 lbs during the first year they're using it. But some people can gain 11 lbs or more during this timeframe.

2. Sulfonylureas like glipizide

Sulfonylureas are another common group of diabetes medications that can cause weight gain. They work by stimulating the pancreas to release insulin. On average, people taking sulfonylureas gain about 5 lbs.

Examples of sulfonylureas include:

• Glimepiride (Amaryl)

• Glipizide (Glucotrol XL)

• Glyburide (Diabeta, Glynase)

3. Thiazolidinediones like pioglitazone

Another group of medication that causes diabetes weight gain is thiazolidinediones (TZDs or "glitazones"). They lower blood glucose by making the body more sensitive to insulin. They also affect genes that are involved in fat cell formation. People taking TZDs can gain about 6 lbs to 9 lbs during the first 6 months and up to 11 lbs over 3 to 5 years.

The two FDA-approved TZDs are:

• Pioglitazone (Actos)

• Rosiglitazone

4. Meglitinides like repaglinide

Meglitinides ("glinides") are another group of diabetes medications. Similar to sulfonylureas, they cause the pancreas to release more insulin. People can gain up to 7 lbs during the first 3 months of starting glinides.

The two available glinides are:

• Nateglinide

• Repaglinide

Why do diabetes medications cause weight changes for some people?

Diabetes medications can cause weight changes by affecting how glucose is used by the body. Insulin is a hormone that helps your body to turn glucose from food into energy for your cells. Insulin helps glucose move from your blood into your cells. This movement lowers your blood glucose.

But when there's too much glucose in the blood, insulin tells your liver to turn that glucose into fat cells. These extra fat cells can lead to weight gain over time.

When people use insulin as a medication, it acts like natural insulin. Until your blood glucose is better balanced, this glucose-into-fat process can keep happening. This is why insulin's weight gain side effect is most expected when you first start it. This side effect also applies to medications that tell your body to make more insulin.

On the flip side, some diabetes medications can cause weight loss by getting rid of extra glucose in your body or lowering how much glucose your liver makes. Less glucose in the blood means there's less glucose available to change into fat. So if a medication works by removing glucose from the blood or lowering how much glucose is made, weight loss is a possible side effect.

Which diabetes medications are likely to have little or no effect on your weight?

Some diabetes medications have little to no effect on weight for most people. Healthcare professionals sometimes call these "weight-neutral" diabetes medications.

Dipeptidyl peptidase-4 (DPP-4) inhibitors like Januvia

Dipeptidyl peptidase-4 (DPP-4) inhibitors ("gliptins") are a commonly-used group of diabetes medications. Sitagliptin (Januvia, Zituvio) is the most well-known DPP-4 inhibitor. These medications lower blood glucose by helping to raise natural levels of GLP-1 in the body.

Studies have shown DPP-4 inhibitors have little effect on body weight. So while medications such as sitagliptin likely won't cause weight loss, they shouldn't cause weight gain either.

Other DPP-4 inhibitors include:

• Alogliptin (Nesina)

• Linagliptin (Tradjenta)

• Saxagliptin

Which side effect is more common with diabetes medications: Weight gain or weight loss?

Neither weight gain nor weight loss is a more common side effect when comparing all diabetes medications. And not everyone experiences body weight changes from diabetes medications. There are several different types of medications available. They work in different ways to help lower blood glucose. The risk of weight gain or weight loss depends on the medication and lifestyle factors, like diet and exercise.

Weight gain can discourage people from continuing their medications. And when people stop taking their diabetes medications, their risks of diabetes complications go up. Make sure to let your healthcare team know if you notice any changes to your weight that you're uncomfortable with. They may recommend changes to your medications to help with this side effect.

How long does it take for diabetes medications to cause weight loss?

Body weight changes may become noticeable within the first few months of starting a diabetes medication. But you may not notice significant weight loss for closer to a year (or longer) with GLP-1 agonists or Mounjaro.

For example, people taking Ozempic lost an average of 8 lbs after 30 weeks (about 7 months) with the 0.5 mg per week dosage. At higher doses (1 mg to 2 mg per week), people lost around 13 lbs to 15 lbs after 40 weeks (about 9 months). With Mounjaro, people lost between 15% and 20% of their starting body weight after taking the medication for 72 weeks (more than 16 months).

Can weight gain from diabetes medication be prevented?

Weight gain from diabetes medications may be preventable. A diabetes-friendly diet and regular exercise play an important role in managing diabetes. These healthy lifestyle changes can help lower blood glucose and lower or maintain weight. But in some cases, these aren't enough for everyone.

It's best to discuss with your healthcare team what changes would be best for you. They may suggest changing your current diabetes medication regimen. Adding or switching to a diabetes medication that causes weight loss may also be an option. But you shouldn't try to adjust your medications or dosages without your prescriber's OK.

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