Efficacy and safety of glucagon-like peptide-1 receptor agonists in the treatment of binge eating disorder in Type 2 diabetic patients: a pilot study in real world clinical practice

BACKGROUND : Binge eating disorder (BED) is the most prevalent eating disorder in the population, poorly studied in patients with Type 2 diabetes mellitus (T2DM). There are no generally accepted guidelines on pharmacological treatment of BED and no studies with more than 3-month duration. Glucagon-like peptide 1 receptor agonists (GLP1RA) could be a promising class of agents for the treatment of BED in T2DM patients due to their effects on central mechanisms of appetite and satiety regulation. AIM : To assess efficacy and safety of GLP1 RA for treatment of BED in patients with T2D. METHODS : Sixty six outpatients with T2DM and BED participated in this pilot open-label prospective comparative study of 6 mo’ duration followed by a 6 mo follow-up after GLP1RA withdrawal. All 66 continued their previous anti-hyperglycemic agents, 33 patients (50%) were prescribed a GLPRA (dulaglutide, or semaglutide, or lixisenatide combined with glargin). ­Thirty three patients were in the control group without GLPRA. In addition to standard clinical and laboratory examinations, all patients completed tests/questionnaires for assessment of their quality of life, depression, stait/trait anxiety, alexithymia and other personality characteristics, and physical complaints. Changes in BED severity and all other parameters were assessed at 3 and 6 months, and BED severity only was assessed at 6 months after the end of GLP1RA. RESULTS : After 6 months of GLP1RA therapy, 63,6% of the patients were in complete remission of BED (р<0,001), 36,3% were in partial remission, and complete form of BED was absent (0%). Along with BED improvement, there was a decrease of body weight from 106,3±17,6 to 98,9±17,2 kg at 6 months (р<0,00001), waist circumference from 118,1±12,5 to 110,1±12,0 cm (р<0,00001), and HbA1c levels by 1,2% from the baseline (р=0,0005). Improvement of BED was associated with positive changes of some psychological parameters, such as depression, hypochondriasis, general (but not diabetes-related) quality of life and psychosomatic complaints. In the control group, BED severity, anthropometric, metabolic, and psychological characteristics remained unchanged. At 6 months, most of the parameters studied in the GLP1RA group were significantly better than in the control. No patients withdrew from the study due to adverse events of GLP1 RA. At 6 months after GLP1RA withdrawal, BED relapsed in all patients. CONCLUSION : GLP1 receptor agonists are effective, safe and well tolerated in the treatment of BED in Type 2 diabetes patients. They facilitate the achievement of the main goal of BED treatment (complete or partial remission of BED) in 100% of the cases with marked improvements in metabolic and a range of psychological parameters.