Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

A woman with type 2 diabetes noticed a 15 lb weight gain over the past 2 years. Which of the following drugs would most likely worsen her weight gain?

1. Pramlintide

2. Exenatide

3. Pioglitazone

4. Saxagliptin

The correct answer is: Pioglitazone

Pioglitazone is a medication belonging to the thiazolidinedione class, which is known to promote weight gain in some patients. This occurs because these medications can cause fluid retention and increase fat accumulation, particularly in subcutaneous adipose tissue. While weight gain may be tolerated or even desirable for some patients, especially those who are underweight or have a history of significant weight loss, it is generally considered a drawback for individuals with type 2 diabetes who are already experiencing weight issues, as it can further exacerbate their metabolic concerns. In contrast, the other medication options typically do not have the same adverse effect on weight. Pramlintide and exenatide both tend to promote weight loss or prevent weight gain, making them more favorable choices for patients concerned about their weight. Saxagliptin, a DPP-4 inhibitor, is generally weight neutral. Thus, among the options presented, pioglitazone stands out as the medication most likely to worsen weight gain in someone who is already experiencing this issue.