Weight Loss With SGLT2 Inhibitors, Semaglutide, and Transcranial Magnetic Stimulation in Type 2 Diabetes and Obesity

Objective: This study compared the efficacy of a GLP-1 receptor agonist (GLP1-RA) (semaglutide, 0.5 mg/week), sodium-glucose cotransporter-2 inhibitors (SGLT2i), and repetitive transcranial magnetic stimulation (rTMS), a new emerging treatment for obesity, in reducing body weight (BW) after 1 year in patients with obesity and type 2 diabetes (T2D). Methods: We included 40 patients with T2D treated with a SGLT2i, 37 patients with T2D treated with the GLP1-RA semaglutide, and 30 patients treated with rTMS in this retrospective comparative analysis. rTMS was administered three times per week for 5 weeks. All patients received dietary advice about moderate caloric restriction (−300 kcal/day). Results: After 12 months the weight loss with rTMS (−8.2 ± 1.0 kg) was not significantly different from that with semaglutide (−5.7 ± 0.9 kg). Weight loss with SGLT2i (−2.0 ± 0.7 kg) was significantly less than with both semaglutide (p = 0.01) and rTMS (p < 0.0001). Individuals receiving SGLT2i therapy experienced weight regain from month 6 to month 12, while BW declined progressively in patients treated with semaglutide and rTMS. Conclusions: Treatment with rTMS produced a comparable reduction in BW to that observed with the GLP1-RA semaglutide (at the dose of 0.5 mg/week) and represents a promising intervention for the treatment of obesity and T2D. Trial Registration: ClinicalTrials.gov identifier: NCT03009695.