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Chair, Javier Morales, MD, FACP, FACE, Juan Pablo Frías, MD, and Donna H. Ryan, MD, FTOS, discuss T2DM and obesity in this CME activity titled “Is Synergism the Secret to Success? Candid Conversations on Targeting GIP and GLP-1 to Individualize Treatment in Patients With T2DM and Obesity.” For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/KZF865. CME credit will be available until May 7, 2023.
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GLP1 drugs are highly effective at weight loss, but it comes at a cost. The approach requires expertise and oversight from an expert. There are several strategies that can help prevent or manage muscle mass loss associated with GLP-1 agonist treatment: ## Resistance Training Incorporating resistance or strength training exercises is one of the most effective ways to preserve and build muscle mass during weight loss[1][2]. This counteracts the catabolic effects of caloric deficit by stimulating muscle protein synthesis. ## Adequate Protein Intake Ensuring sufficient dietary protein intake, ideally 1.6-2.2 g/kg of ideal body weight per day, can help minimize muscle loss[2]. Protein provides amino acids needed for muscle maintenance and repair. ## Combining with Myostatin Inhibitors Myostatin is a key negative regulator of muscle growth. Blocking myostatin with investigational drugs like apitegromab (SRK-439) from Scholar Rock may enhance muscle growth and prevent muscle loss when combined with GLP-1 agonists[1]. Early clinical trials are underway to test this approach. ## Using Activin Receptor Inhibitors Activin receptor inhibitors like those being developed by companies like Regeneron can block activin signaling and potentially increase muscle mass when used alongside GLP-1 medications[3]. ## mTOR Activators The mTOR pathway regulates muscle protein synthesis. Drugs that activate mTOR, such as the PPAR agonist enobosarm being tested by Veru, may preserve muscle when combined with GLP-1 treatment[5]. ## Adequate Vitamin D and Calcium Ensuring sufficient vitamin D and calcium intake is important for preserving bone mineral density, which can be impacted by the weight loss and muscle loss induced by GLP-1 agonists[2]. The key is utilizing a multi-modal approach combining GLP-1 agonists with resistance exercise, optimal nutrition, and emerging muscle-preserving medications to maximize fat loss while minimizing the loss of metabolically active lean muscle mass[1][2][3]. Citations: [1] https://pharmanewsintel.com/features/addressing-muscle-loss-associated-with-glp-1-medication-use [2] https://www.medscape.com/viewarticle/994030 [3] https://www.tctmd.com/news/dont-worry-about-muscle-loss-glp-1-inhibitors-viewpoint-asserts [4] https://www.uclahealth.org/news/article/rapid-weight-loss-can-lead-loss-muscle-mass [5] https://www.drugdiscoverytrends.com/glp-1-impact-lean-mass/
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