Researchers tested three different treatments to help people with type 2 diabetes and obesity lose weight over one year. They compared a newer brain stimulation technique called rTMS with two popular medications: semaglutide (a GLP-1 drug) and SGLT2 inhibitors. The brain stimulation treatment worked almost as well as semaglutide, helping people lose about 8 pounds. The SGLT2 inhibitor medication helped people lose only about 2 pounds, and they started gaining weight back after 6 months. This suggests that brain stimulation might be a helpful new option for people struggling with weight loss.

The Quick Take

  • What they studied: Whether three different treatments—a brain stimulation technique, a popular weight-loss medication, and a diabetes medication—could help people with type 2 diabetes lose weight
  • Who participated: 107 adults with type 2 diabetes and obesity: 40 taking SGLT2 inhibitors, 37 taking semaglutide, and 30 receiving brain stimulation treatment (rTMS)
  • Key finding: After one year, brain stimulation (rTMS) helped people lose about 8.2 pounds, which was similar to semaglutide’s 5.7 pounds. The SGLT2 inhibitor only helped people lose 2 pounds, and people started regaining weight after 6 months
  • What it means for you: If you struggle with weight loss and have type 2 diabetes, brain stimulation might be a new option worth discussing with your doctor, especially if medications aren’t working well for you. However, this is early research, and more testing is needed before it becomes widely available

The Research Details

This was a retrospective comparative analysis, meaning researchers looked back at records of patients who had already received different treatments and compared their results. The study included 107 people with type 2 diabetes and obesity who received one of three treatments: SGLT2 inhibitor medication, semaglutide (a GLP-1 medication), or repetitive transcranial magnetic stimulation (rTMS), which is a non-invasive brain stimulation technique. All patients also received dietary advice to reduce their daily calories by about 300 calories. The rTMS treatment was given three times per week for 5 weeks. Researchers measured how much weight each group lost after 12 months and compared the results between groups.

This research design allows doctors to compare real-world results from different treatments in actual patients. By looking at what happened to people who received each treatment, researchers can see which approaches work best. This type of study is useful for identifying promising new treatments like rTMS that might help people who don’t respond well to current medications.

This study has some important limitations to consider. It’s a retrospective study, which means it looks at past records rather than following patients forward in time. The groups were relatively small (30-40 people per treatment), which means results might change with larger studies. The study was not randomized, meaning patients weren’t randomly assigned to treatments, so there could be differences between groups that affected results. However, the study was registered on ClinicalTrials.gov, which adds credibility to the research.

What the Results Show

After 12 months, the brain stimulation treatment (rTMS) produced weight loss of about 8.2 pounds, which was not significantly different from semaglutide’s weight loss of 5.7 pounds. This means both treatments worked similarly well. The SGLT2 inhibitor medication produced much less weight loss—only about 2 pounds—which was significantly less than both other treatments. An important difference appeared over time: people taking semaglutide and those receiving rTMS continued to lose weight throughout the year. However, people taking the SGLT2 inhibitor started gaining weight back between month 6 and month 12, suggesting the medication’s weight-loss effect may wear off over time.

The study showed that rTMS, a non-medication approach, produced results comparable to a popular weight-loss medication. This is significant because it suggests brain stimulation might help people who can’t take medications due to side effects or other health conditions. The progressive weight loss with rTMS and semaglutide, compared to weight regain with SGLT2 inhibitors, suggests these treatments may work differently in the body. The fact that rTMS required only 5 weeks of treatment (three times per week) while producing sustained weight loss is also noteworthy.

Semaglutide is already known to be effective for weight loss in people with type 2 diabetes, so this study confirms previous findings. SGLT2 inhibitors are primarily diabetes medications that have some weight-loss benefits, but this study shows they’re less effective than semaglutide for weight loss specifically. The rTMS results are more novel—this is an emerging treatment for obesity, and this study suggests it may work as well as semaglutide, which is an important finding that could change how doctors think about obesity treatment.

The study looked back at past medical records rather than following patients forward, which can introduce errors. The groups were small (30-40 people each), so results might be different with larger groups. Patients weren’t randomly assigned to treatments, so differences between groups (like age, severity of obesity, or other health conditions) might have affected results. The study doesn’t explain why some people responded better to treatments than others. The rTMS treatment was only given for 5 weeks, so it’s unclear if more treatment would produce better results. Finally, this study only followed people for one year, so we don’t know if the benefits last longer.

The Bottom Line

If you have type 2 diabetes and obesity, discuss all three options with your doctor: GLP-1 medications like semaglutide, SGLT2 inhibitors, or brain stimulation (rTMS). Based on this research, GLP-1 medications and rTMS appear more effective for weight loss than SGLT2 inhibitors alone. However, this is early research, and your doctor should consider your individual health situation, other medications, and personal preferences. Confidence level: Moderate—this is promising research, but larger studies are needed before making firm recommendations.

This research is most relevant for people with type 2 diabetes who are struggling with obesity and weight loss. It may be especially interesting for people who haven’t had good results with SGLT2 inhibitors or who want to explore non-medication options. People without type 2 diabetes should wait for more research before considering rTMS for weight loss. Pregnant women, people with certain mental health conditions, or those with metal implants in their heads should not use rTMS without careful medical evaluation.

Based on this study, you might expect to see weight loss within the first few months of treatment. With semaglutide and rTMS, weight loss appeared to continue throughout the year. With SGLT2 inhibitors, weight loss plateaued and reversed after about 6 months. However, individual results vary significantly, and some people may see faster or slower results.

Want to Apply This Research?

  • Track weekly weight measurements and monthly body measurements (waist, hip, chest). Also track energy levels, hunger levels (1-10 scale), and blood sugar readings if you have diabetes. This helps you see patterns and whether the treatment is working for you personally.
  • Use the app to log your daily calorie intake (aiming for 300 calories less than usual), track which treatment you’re using, and set weekly weight-loss goals. Set reminders for medication doses or rTMS appointments. Log how you feel each day to notice mood or energy changes that might relate to your treatment.
  • Check your weight weekly at the same time of day and track the trend over months rather than day-to-day changes. Create a chart showing your progress over 3, 6, and 12 months. Share this data with your doctor at regular appointments to see if your treatment is working and whether adjustments are needed. If using rTMS, track appointment attendance and any side effects. If taking medication, track whether you’re taking it consistently.

This research is preliminary and should not replace medical advice from your doctor. The study was small and looked back at past records rather than following patients forward. Before starting any weight-loss treatment—whether medication or brain stimulation—discuss your options with your healthcare provider. They can help determine which treatment is safest and most appropriate for your individual health situation, considering your other medications, health conditions, and personal preferences. If you’re pregnant, breastfeeding, or have certain medical conditions, some of these treatments may not be suitable for you. Always inform your doctor about all treatments you’re considering.