Januvia (sitagliptin) is a prescription medication primarily used to manage blood sugar levels in adults with type 2 diabetes. While not specifically approved for weight loss, its effects on body weight have been a topic of interest. This article explores the relationship between Januvia and weight loss, its mechanisms of action, potential side effects, and other relevant considerations.
What is Januvia (Sitagliptin)?
Januvia is a brand name for sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor. Sitagliptin is one of the DPP-4 inhibitors which prevent the inactivation of incretins, increasing the endogenous active incretin levels. Incretins are hormones released from the intestinal cells following meal ingestion, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). The GLP-1 and GIP stimulate insulin secretion from pancreatic β-cells and the GLP-1 inhibits glucagon secretion from pancreatic α-cells, which reduces plasma glucose levels. However, incretins are rapidly inactivated by the dipeptidyl peptidase-4 (DPP-4) after released from the intestinal cells. By inhibiting DPP-4, sitagliptin increases the levels of these natural hormones in the body, helping to control blood sugar levels.
It is used along with diet and exercise to lower blood sugar in adults with Type 2 diabetes. Sitagliptin also lowers the production of glucagon, a hormone that stimulates the liver to make glucose. Some patients may take Januvia as a stand-alone treatment for diabetes. More frequently, however, people take Januvia along with one or two other diabetes drugs such as metformin, pioglitazone, glimepiride, or insulin.
Januvia can be used alone or in combination with other diabetes drugs, but should not be used to treat type 1 diabetes. This is because the drug works by improving the body’s ability to properly utilize the insulin it already makes. The drug is only part of a treatment program which also includes diet, exercise and weight control. You should not use the drug to treat type 2 diabetes if you are in a state of diabetic ketoacidosis or you are allergic to sitagliptin.
Does Januvia Cause Weight Loss?
Studies suggest that obese type 2 diabetes patients may experience slight weight loss while taking Januvia. However, it is not a primary weight-loss medication. Taking this medicine alone, without adopting a healthy lifestyle such as regular exercise and diet, does not result in weight loss. People who took this medication and did exercise and follow a healthy diet lost significantly more weight.
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Januvia is considered weight-neutral, unlike some other Type 2 diabetes medications that are associated with weight gain. Some studies suggest Januvia may promote weight loss when combined with metformin, but other studies do not.
Clinical Evidence
A retrospective study of 220 type 2 diabetic patients in Japan who had taken sitagliptin for 6 months showed that body weight was significantly reduced after 6-month sitagliptin treatment by 0.8 kg. HbA1c levels were also significantly decreased after the sitagliptin treatment by 0.6%.
Several studies have examined the effect of sitagliptin on weight:
- In Colombia, patients treated with sitagliptin 100 mg monotherapy for 24 weeks showed a body weight change from baseline of -0.6 kg.
- In Turkey, sitagliptin 100 mg monotherapy for 12 weeks provided a reduction in body weight from baseline by 2.0 kg.
- The addition of sitagliptin (100 mg) to ongoing pioglitazone therapy for 6 months decreased body weight by 0.6 kg among patients in Italy.
- In Japan, sitagliptin (100 mg) monotherapy for 12 weeks showed a change from baseline body weight of -0.1 kg.
- Sitagliptin (50 mg) monotherapy for 12 weeks decreased body weight from baseline by 0.27 kg.
These studies suggest that the effect of sitagliptin on body weight can vary. In some cases, it leads to modest weight loss, while in others, it has a neutral effect.
How Januvia May Influence Weight
It is not yet fully established how this medication causes or aids weight loss. However, several factors may contribute to the observed weight changes:
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- Reduced Urinary Glucose Excretion: Sitagliptin has been shown to reduce urinary glucose excretion, which suggests that body weight reduction following the sitagliptin treatment was not due to increased urinary glucose excretion, may be due to a decrease in food intake or an increase in energy expenditure.
- Increased Satiety: Increases in GLP-1 concentration have been reported to increase satiety, which could induce a decrease in food intake following DPP-4 inhibitors treatment.
- Resting Energy Expenditure: Fasting GLP-1 concentration has been reported to be positively correlated with resting energy expenditure.
Important Considerations
Individual Variability
It's important to note that individual responses to Januvia can vary. Factors such as baseline BMI, diet, exercise habits, and other medications can influence whether a person experiences weight loss while taking Januvia.
In the Japanese study, a significant and negative correlation was found between change in body weight and BMI at baseline, suggesting that individuals with higher BMI at the start of treatment may experience more weight loss.
Not a Primary Weight Loss Medication
Januvia is primarily prescribed to manage blood sugar levels in people with type 2 diabetes. While weight loss may be an additional benefit for some patients, it should not be considered a primary weight-loss medication.
Lifestyle Modifications
Adopting a healthy lifestyle, including regular exercise and a balanced diet, is crucial for achieving and maintaining weight loss. Januvia may complement these efforts, but it is not a substitute for them.
Potential Side Effects of Januvia
Remember that your doctor prescribed this medication because they believe that the benefit of taking this medication outweighs the risk. Januvia can lead to side effects such as allergic reactions with symptoms like hives, difficulty breathing and swelling of tongue, face, lip or throat. Taking this medication can also lead to pancreatitis. If you notice symptoms such as loss of appetite, fast heartbeat, nausea, or pain in upper stomach that spreads to your back, you should stop taking this medication and seek medical help immediately.
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As with all medications, Januvia can cause side effects. Common side effects include:
- Stuffy nose
- Back pain
- Headache
- Diarrhea
- Constipation
- Muscle pain
- Stomach pain
Serious side effects are rare but can occur:
- Low blood sugar
- Skin reactions
- Heart failure
- Pancreatitis (swelling of the pancreas)
- Severe joint pain
- Severe kidney problems, such as acute (sudden) kidney failure
- Allergic reaction
Januvia Drug Interactions
The most significant Januvia drug interactions involve blood sugar. For this reason, other gliptins are to be avoided outright. However, Januvia is normally prescribed along with at least one other diabetes medication (in a different diabetes drug class) that reduces blood sugar. However, when Januvia is taken with sulfonylureas or insulin, the risk of hypoglycemia rises significantly. Other prescription drugs may also reduce blood sugar. When taken with Januvia, there’s a small chance the combination might lead to hypoglycemia or even severe hypoglycemia.
Combining Januvia with beta blockers will require careful monitoring of blood sugar levels. Digoxin is used to treat heart failure. When combined with Januvia, the concentration of digoxin in the blood increases slightly, possibly raising the risk of adverse effects.
Doctor’s Recommendation
DPP-4 inhibitors like Januvia are often considered second-line treatments compared to GLP-1 agonists because their benefits are somewhat smaller. Januvia is a good option for patients with kidney problems since it can be used with adjustments in dosage if kidney function is reduced (eGFR less than 45 ml/min/1.73m²) or for those with slow gastric emptying issues. The AAFP also notes that combining GLP-1 agonists with DPP-4 inhibitors doesn’t provide additional benefits. Overall, DPP-4 inhibitors are rarely used but may be helpful in critical care settings.