A 48-year-old man with type 2 diabetes and obesity (BMI 34 kg/m²) has an HbA1c of 8.4% on metformin 2000 mg daily. He wants a medication that will also help with weight loss. Which drug should be added?
- A Glimepiride
- B Liraglutide ✓
- C Pioglitazone
- D Gliclazide
Correct answer: B. Liraglutide
Explanation
Liraglutide, a GLP-1 receptor agonist, produces significant weight loss through delayed gastric emptying and central appetite suppression via hypothalamic GLP-1 receptors. Glimepiride and gliclazide (sulfonylureas) and pioglitazone (thiazolidinedione) all cause weight gain. GLP-1 agonists and SGLT2 inhibitors are the preferred agents in obese diabetic patients when weight reduction is desired.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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