Lorcaserin: Can This New Weight Loss Drug Delay or Reverse Diabetes?

A prescription weight loss drug, lorcaserin (Belviq), helps not only with weight loss but also in reversing diabetes or delaying its onset, according to new research involving 12,000 people.

medication and a tape measureResults of a large, new study reveal evidence that lorcaserin can assist with weight loss and delay the onset of diabetes. (Photo: 123rf)

Results of the research offer some compelling evidence. Lorcaserin (Belviq) "led to durable weight loss over several years and reduced the risk of developing diabetes in those with prediabetes and improved diabetes control in patients who had diabetes already," says Erin Bohula, MD, DPhil, lead author of the study, presented at the European Association for the Study of Diabetes and published simultaneously in The Lancet.1

While the researchers ''had a pretty strong idea'' we would see this, the research adds some solid proof, she tells OnTrackDiabetes. The study was funded by Easai, which makes Belviq.

While the researchers call the study results good news, another expert not involved in the study expressed some cautions, citing costs, among other factors.

Study Details

Dr. Bohula and her colleagues randomly assigned the 12,000 people to either lorcaserin or placebo and followed them up for a median of 3.3 years (half longer, half less). At the start, about 57% had diabetes, 33% prediabetes and about 10% had normal blood sugars. All were overweight or obese and either were at risk for atherosclerotic vascular disease or already had it.

They took 10 milligrams of lorcaserin twice daily or the same pill dose and frequency in a placebo pill.

Compared with those taking placebo, weight loss at the one-year mark was:

  • 5.7 pounds for those with diabetes
  • 6.2 for those with pre-diabetes
  • 7.3 for those with normal blood sugars

Compared with placebo, the diet drug reduced the incidence of getting diabetes by 19% in those with prediabetes at the start and by 23% in those with normal sugars at the start. In addition, 9% of those with prediabetes taking the medication were able to get back to normal blood sugar levels, compared to 7.6% of those on placebo.  In those with diabetes at the start, 7% of those on the diet drug achieved remission of their high blood sugar, while just 6% of those on the placebo did.

While 39% of the diet drug group lost at least 5% of body weight—known to help stabilize blood sugar17% of the placebo group did.

Those with diabetes at the study start had well-controlled diabetes with their diabetes medicines, but the diet drug still helped reduce their hemoglobin A1C levels by .33% at the one year mark. The medicine also reduced the risk of complications such as eye issues and nerve issues.

In those who had diabetes at the start, severe hypoglycemia with serious complications was not common, but was more apt to occur in those on the medication than not. While 12 in the medication group were affected, just 4 in the placebo group were.

Expert Opinions

Weight loss is important, both for reducing the risk of developing diabetes in those who don't have it and in reducing blood sugars in those who do, says Caroline Apovian, MD, FACN, FACP, professor of medicine and pediatrics, Boston University School of Medicine and director, Center for Nutrition and Weight Management at Boston Medical Center. She is on the editorial board of OnTrack Diabetes. She was not involved in the study but commented on the findings.

"We have been using lorcaserin in patients with obesity, with and without diabetes," she tells OnTrackDiabetes. Weight losses of about 5 percent of starting weight—for instance, a 10-pound loss in a 200-pound person—''really improve metabolic parameters and improve health."

There is no doubt that lorcaserin can help with weight loss, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE, a certified diabetes educator and transitional program coordinator at the Kovler Diabetes Center, Chicago. She is also an editorial board member for OnTrackDiabetes.

"We are all well aware of the effect of weight loss on insulin resistance and blood glucose control in type 2 diabetes—it is the cornerstone of diabetes recommendations," she says. Even so, she has a caveat about Belviq. "The problem has to do with insurance coverage and the cost of the product," she says.

Online pricing shows that a one-month supply of the dose used in the new study retails for $285 and higher.  Even if the drug is covered, she says, patients may still have to shell out cash in a copay in order to get it. Those with type 2 diabetes are probably already on multiple medications so it could pose a financial issue.

On its web page, Eisai lists a toll-free number, 866-613-4724, to inquire about patient assistance programs for Belviq.

Dr. Bohula acknowledges that cost could be an issue. "I think that has to be factored in," she says about costs.

Those who do decide to take weight loss drugs, she says, have to be careful to check their blood sugar levels, she says. When weight loss occurs, they may require lower doses of their diabetes medicines.

In the study, Dr. Bohula adds, they tested the medication within a program of diet and exercise, so people not willing to spend the money for the drug could focus on diet and exercise for weight loss.

Dr. Apovian has no relevant disclosures. Dr. Bohula reports study funding from Eisai. Hess-Fischl is a consultant for Abbott Diabetes Care, a stock/shareholder with Roche Diagnostics and is on the speakers' bureau for Sanofi Aventis and Eli Lilly.

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