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View January 10: Semaglutide is not Associated with a Higher Risk of Suicidal Ideation; Obesity Management in Adults

10 Jan 2024 8:31 AM | Anonymous

Semaglutide is not Associated with a Higher Risk of Suicidal Ideation
Submitted by: Nathanial Schreiner PhD, MBA, RN

With the increasing use of glucagon-like peptide 1 receptor (GLP1R) agonist medication, such as semaglutide, for treatment of Type II diabetes and obesity, severe adverse side effects of suicidal ideation have been reported. To further investigate these reports, researchers retrospectively examined electronic medical health records of 232,771 patients taking anti-obesity medications who exhibited no previous suicidal ideation. The main analysis compared the odds' ratio of patients having suicidal ideation between two groups of patients: semaglutide vs. non GPL1R anti-obesity medications (bupropion, naltrexone, orlistat, topiramate, phentermine, setmelanotide). After propensity matching among patients in the two groups, which resulted in 52,783 patients per group, charts were examined for a 6-month period from when the anti-obesity medication was given. Findings determined that the semaglutide group reported statistically significant fewer incidences of suicidal ideation vs the non-GLP1R group (0.11% versus 0.43%; hazard ratio (HR) = 0.27, 95% confidence interval (CI) = 0.20–0.36). Furthermore, the semaglutide group had no reports of suicide attempts vs 14 in the non-GPL1R group (p<.001). Similar findings were replicated in a sample of patients (n= 1,572,885) taking selaglutide vs. non-GLP1R agonist anti-diabetes medication (insulin, metformin, sulfonylureas, alpha glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium/glucose co-transporter 2 (SGLT2) inhibitors) for management of Type II diabetes.

References:

Wang, W., Volkow, N.D., Berger, N.A. et al. Association of semaglutide with risk of suicidal ideation in a real-world cohort. Nat Med (2024). https://doi.org/10.1038/s41591-023-02672-2

Association of semaglutide with risk of suicidal ideation in a real-world cohort. Nat Med (2024). https://doi.org/10.1038/s41591-023-02672-2

Obesity Management in Adults
Submitted by: Linda Baas

Obesity affects approximately 42% of adults in the US. Management of obesity in adults is a major clinical problem due to the associated risk for cardiovascular disease, diabetes, osteoarthritis, sleep disorders, and premature death. While Body Mass Index has problems in assessing obesity, it is commonly used as a practical measurement. A BMI greater than 25 is overweight, and greater than 30 is obese. A weight loss of 5-10% can reduce systolic blood pressure by 3 mm Hg in an obese person with hypertension and decrease HgbA1c 0.6 to 1% in type 2 DM. This review was conducted to evaluate the outcomes of different guideline recommended approaches to the management of obesity.

The first category of obesity treatment consists of multi-component behavioral intervention of at least 14 sessions over 6 months. These lifestyle programs included weight self-monitoring, dietary and activity counseling and problem-solving resulted in a 5-10% weight loss. However, 25% of these subjects regain weight at 2 years. The second category consists of anti-obesity medications including GLP-1 inhibitors in conjunction with lifestyle can result in 8- 21% of weight loss. The third category is laparoscopic sleeve gastroplasty, and it can result in 10-13% weight loss. The final approach is bariatric surgery, which can result in 25-30% weight loss. This systematic review examined the literature to assess the benefits of various approaches to the management of obesity. It is helpful to consider the results of this review when working with patients. Of course, each approach has many other concerns related to side effects and complications.

References:

Elmaleh-Sachs A, Schwartz JL, Bramante CT, Nicklas JM, Gudzune KA, Jay M. Obesity Management in Adults: A Review. JAMA. 2023;330(20):2000–2015. doi:10.1001/jama.2023.19897



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