Affiliation:
1. Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania
2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
3. Schwartz Center and Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
Abstract
OBJECTIVE—Moderate weight loss is recommended for overweight and obese patients with type 2 diabetes, and conjunctive use of weight loss medication has been advocated. The current study examined weight loss–dependent and –independent effects of the intestinal lipase inhibitor orlistat at 6 months of treatment, using behavioral intervention (Int) combined with randomized, double-blinded, placebo (P)-controlled treatment with orlistat (O).
RESEARCH DESIGN AND METHODS—Metabolic control, insulin sensitivity (IS), regional fat distribution, and fat content in liver and muscle were measured in 39 volunteers with type 2 diabetes in whom all antidiabetic medication was withdrawn 1 month preceding randomization. Weight loss was equivalent in the Int+O and Int+P groups, respectively (−10.3 ± 1.3 vs. −8.9 ± 1.1%), and there were identical decreases in visceral adipose tissue (VAT), fat mass (FM), thigh adiposity, and hepatic steatosis.
RESULTS—Weight loss resulted in substantial improvement (P < 0.001) in HbA1c (−1.6 ± 0.3 vs. −1.0 ± 0.4%; NS between groups). IS improved significantly more with orlistat (Δ2.2 ± 0.4 vs. Δ1.2 ± 0.4 mg · min−1 · kg−1 fat-free mass [FFM]; P < 0.05), and plasma free fatty acid (FFA) levels were strongly correlated with IS (r = 0.56; P < 0.001). Orlistat caused greater reductions in fasting plasma FFA (Δ–154 ± 22 vs. Δ–51 ± 33 μmol/l; P < 0.05), insulin-suppressed FFA (Δ–119 ± 23 vs. Δ–87 ± 34 μmol/l; P < 0.05), and fasting plasma glucose (FPG; −62 ± 9 vs. −32 ± 8 mg/dl; P = 0.02). Changes in HbA1c were correlated with ΔIS (r = −0.41; P < 0.01) but not with weight loss per se.
CONCLUSIONS—At equivalent weight loss, conjunctive use of orlistat resulted in greater improvement in FFA levels and IS.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
124 articles.
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