Dulaglutide treatment reduces binge eating behaviors in individuals with type 2 diabetes (T2D) and binge eating disorder (BED) more effectively than treatment with a sulfonylurea, according to the results of a 12-week, open-label, prospective controlled study published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews.
Studies have shown that activation of the naturally-occurring hormone glucagon-like peptide-1 (GLP-1) increases satiety because of its involvement in the slowing of gastric emptying and decreasing intestinal motility. Moreover, magnetic resonance imaging studies have shown that GLP-1 receptor activation can affect appetite regulation and therefore may counteract food cravings and overeating, and preclinical studies have indicated that GLP-1 agonists reduced binge eating in animal models.
Dulaglutide is a synthetic GLP-1 analog that has been shown to be effective in reducing the body weight of patients with T2D when compared with insulin glargine or other oral hypoglycemic drugs, and has been shown to improve the quality of life in these individuals. Whether treatment with dulaglutide can reduce the frequency of binge eating episodes and improve anthropometric and metabolic variables better than treatment with other diabetes medications in individuals with T2D and BED has not yet been determined.
To examine this, 60 patients with T2D (46.6% men) with BED were randomly assigned into treatment groups that received either 150 mg/wk of dulaglutide or 60 mg/d of gliclazide modified release for 12 weeks in addition to their daily dose of 2 to 3 mg of metformin. To be included in the study, individuals were required to have been diagnosed with T2D and only be using metformin for treatment, to have hemoglobin 1Ac (HbA1c) between 7.5% and 9%, to be <65 years of age, and to have met Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria for BED in an Eating Disorder Examination interview conducted by a physician after a positive score on the self-reported Binge Eating Scale questionnaire. At baseline, the average age of patients was 54.6±7.7 years, average body mass index (BMI) was 36.4±6.2 kg/m2, and 80% of patients were categorized as obese (BMI ≥30 kg/m2).
After 12 weeks, patients treated with dulaglutide had greater decreases in binge eating behavior (P <.0001), body weight (P <.0001), BMI (P <.0001), percentage body fat mass (P <.0001), and HbA1c (P =.009) compared with individuals treated with gliclazide. Additional analysis showed that binge eating behavior was independently and directly related to changes in body weight (P <.0001) and HbA1c (P =.033).
Overall, the study showed that dulaglutide is more effective than gliclazide in improving binge eating behaviors and related metrics. The effect sizes of dulaglutide on body weight, BMI, and body fat composition were significantly greater in the current study than in previous studies of dulaglutide for longer durations in patients with diabetes who did not have BED, indicating that the drug may be especially effective in patients with binge eating behaviors. These results, when considered along with the results of another study that showed liraglutide improved binge eating behaviors in nondiabetic patients, support GLP-1 analogs as a potential treatment for BED.
A limitation to this study was its small sample size and short duration, warranting longer studies with larger patient samples and additional treatment groups.
Da Porto A, Casarsa V, Colussi G, Catena C, Cavarape A, Sechi L. Dulaglutide reduces binge episodes in type 2 diabetic patients with binge eating disorder: a pilot study [published online March 31, 2020]. Diabetes Metab Syndr. doi:10.1016/j.dsx.2020.03.009