Abstract
Weight reduction has been shown to improve glycemic control and cardiovascular risk factors associated with insulin resistance in obese individuals with type 2 diabetes mellitus. Therapeutic options for these patients include promoting weight loss (non-pharmacologic and pharmacologic treatment) and improving glycemic control, as well as treating common associated risk factors such as arterial hypertension and dyslipidemias. This article provides an overview of anti-obesity drugs used in the treatment of obese individuals with type 2 diabetes. The most widely investigated drugs, sibutramine and orlistat, result in modest, clinically worthwhile weight loss, with demonstrable improvements in many co-morbidities, among them, type 2 diabetes. Clinical trials with these anti-obesity medications in cohorts of obese diabetic patients have been reviewed as well as cathecolaminergic agents (diethylpropion [amfepramone], fenproporex, mazindol, ephedrine-caffeine combination), serotoninergic drugs (fenfluramine, dexfenfluramine, fluoxetine), and other drugs that have some action on weight loss (the antidiabetic agent metformin, anti-epileptic agents topiramate and zonisamide, and the antidepressive bupropion [amfebutamone]). These trials show variable benefits in terms of effects on glucose profiles.
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References
Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. N Engl J Med 1999; 341: 427–34
WHO Consultation on Obesity. Obesity: preventing and managing the global epidemic. Geneva: WHO, 1997
Kissebah AH, Krakower GR. Regional adiposity and morbidity. Physiol Rev 1994; 7: 761–811
Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24: 683–9
Astrup A, Finer N. Redefining type 2 diabetes: ‘diabesity’ or ‘obesity dependent diabetes mellitus’? Obes Rev 2000; 1: 57–60
Scheen AJ. Obesity, type 2 diabetes and dyslipidaemia. In: Medeiros-Neto G, Halpern A, editors. Progress in obesity research: 9. Montrouge: John Libbey Eurotext, 2003: 931–5
Lewis GF, Carpentier A, Adeli K, et al. Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes. Endocr Rev 2002; 23: 201–29
Ravussin E, Smith SR. Increased fat intake, impaired fat oxidation, and failure of fat cell proliferation result in ectopic storage, insulin resistance, and type 2 diabetes mellitus. Ann N Y Acad Sci 2002; 967: 363–78
Hillier TA, Pedula KL. Characteristics of an adult population with newly diagnosed type 2 diabetes. Diabetes Care 2001; 24: 1522–7
Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343–50
11. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393–403
Malerbi DA, Franco LJ. Multicentric study of the prevalence of diabetes mellitus and impaired tolerance in urban Brazilian population aged 30–69 years. Diabetes Care 1992; 15: 1509–16
Pi-Sunyer FX. A review of long-term studies evaluating the efficacy of weight loss in ameliorating disorders associated with obesity. Clin Ther 1996; 18: 1006–35
Williams KV, Kelley DE. Metabolic consequences of weight loss on glucose metabolism and insulin action in type 2 diabetes. Diabetes Obes Metab 2000; 2: 121–9
Hu FB, Willett WC. Optimal diets for prevention of coronary heart disease. JAMA 2002; 288: 2569–78
Schulze MB, Hu FB. Dietary approaches to prevent the metabolic syndrome: quality versus quantity of carbohydrates. Diabetes Care 2004; 27: 613–4
Pereira MA, Jacobs Jr DR, Pins JJ, et al. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr 2002; 75: 848–55
McKeown NM, Meigs JB, Liu S, et al. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 2004; 27: 538–46
Albu J, Raja-Khan N. The management of the obese diabetic patient. Prim Care 2003; 30: 465–91
Scheen AJ, Ernest P. New antiobesity agents in type 2 diabetes: overview of clinical trials with sibutramine and orlistat. Diabetes Metab 2002; 28 (6 Pt 1): 437–45
Halpern A, Mancini M. Treatment of obesity: an update on antiobesity medications. Obes Rev 2003; 4: 25–42
National Institutes of Health/National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998; 6: 51S–210S
Samanin R, Garattini S. Neurochemical mechanism of action of anorectic drugs. Pharmacol Toxicol 1993; 73: 63–8
Harris SC, Ivy AC, Searle LM. The mechanism of amphetamine-induced loss of weight. JAMA 1947; 134: 1468–75
Petrie JC, Bewsher PD, Mowat JA, et al. Metabolic effects of fenfluramine: a double-blind study. Postgrad Med J 1975; 51: 139–44
Crommelin RM. Nonamphetamine, anorectic medication for obese diabetic patients: controlled and open investigations of mazindol. Clin Med 1974; 12: 20–4
Turtle JR, Burgess JA. Hypoglycemic action of fenfluramine in diabetes mellitus. Diabetes 1973; 22: 858–67
Andersen PH, Richelsen B, Bak J, et al. Influence of short-term dexfenfluramine therapy on glucose and lipid metabolism in obese non-diabetic patients. Acta Endocrinol (Copenh) 1993; 128: 251–8
Tauber-Lessen E, Damsbo P, Henriksen JE, et al. Improvement of glycemic control and weight loss in type 2 (non-insulin dependent) diabetics after one year of dexfenfluramine treatment [abstract]. Diabetologia 1990; 33Suppl. 1: A124
Stewart GO, Stein GR, Davis T, et al. Dexfenfluramine in type II diabetes: effect on weight and diabetes control. Med J Aust 1993; 158: 167–9
Willey KA, Molyneaux LM, Overland JE, et al. The effects of dexfenfluramine on blood glucose control in patients with type 2 diabetes. Diabet Metab 1992; 9: 341–3
Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997; 337: 581–8
Fuller RW. Serotonin uptake inhibitors: uses in clinical therapy and in laboratory research. Prog Drug Res 1995; 45: 167–204
McGuirk J, Silverstone T. The effect of the 5-HT re-uptake inhibitor fluoxetine on food intake and body weight in healthy male subjects. Int J Obes Relat Metab Disord 1990; 14: 361–72
Foltin RW, Haney M, Comer SD, et al. Effect of fluoxetine on food intake of humans living in a residential laboratory. Appetite 1996; 27: 165–81
Gray DS, Fujioka K, Devine W, et al. A randomized double-blind clinical trial of fluoxetine in obese diabetics. Int J Obes Relat Metab Disord 1992; 16Suppl. 4: S67–72
Darga LL, Carroll-Michals L, Botsford SJ, et al. Fluoxetine’s effect on weight loss in obese subjects. Am J Clin Nutr 1991; 54: 321–5
Goldstein DJ, Rampey Jr AH, Roback PJ, et al. Efficacy and safety of long-term fluoxetine treatment of obesity: maximizing success. Obes Res 1995; 3Suppl. 4: 481S–90S
Fujioka K, Seaton TB, Rowe E, et al. Sibutramine/Diabetes Clinical Study Group: weight loss with sibutramine improves glycaemic control and other metabolic parameters in obese patients with type 2 diabetes mellitus. Diabetes Obes Metab 2000; 2: 175–87
Finer N, Bloom SR, Frost GS, et al. Sibutramine is effective for weight loss and diabetic control in obesity with type 2 diabetes: a randomised, double-blind, placebo-controlled study. Diabetes Obes Metab 2000; 2: 105–12
Gokcel A, Karakose H, Ertorer EM, et al. Effects of sibutramine in obese female subjects with type 2 diabetes and poor blood glucose control. Diabetes Care 2001; 24: 1957–60
Redmon JB, Raatz SK, Reck KP, et al. One-year outcome of a combination of weight loss therapies for subjects with type 2 diabetes: a randomized trial. Diabetes Care 2003; 26(9): 2505–11
McNulty SJ, Ur E, Williams G, et al. Multicenter Sibutramine Study Group: a randomized trial of sibutramine in the management of obese type 2 diabetic patients treated with metformin. Diabetes Care 2003; 26(1): 125–31
Serrano-Rios M, Mechionda N, Moreno Carretero E, et al. Role of sibutramine in the treatment of obese type 2 diabetic patients receiving sulphonylurea therapy. Diabetic Med 2002; 19: 119–24
Rissanen A, for the Finnish Multicentre Group. Sibutramine in the treatment of obese type II diabetics [abstract]. Int J Obes 1999; 23Suppl. 5: S63
Arterburn DE, Crane PK, Veenstra DL. The efficacy and safety of sibutramine for weight loss: a systematic review. Arch Intern Med 2004; 164: 994–1003
Zhi J, Melia AT, Eggers H, et al. Review of limited systemic absorption of orlistat, a lipase inhibitor, in healthy human volunteers. J Clin Pharmacol 1995; 35: 1103–8
Aronne LJ. Modern medical management of obesity: the role for pharmacological intervention. J Am Diet Assoc 1998; 98 Suppl. 2: S23–6
Reaven G, Karen S, Hauptman J, et al. Effect of orlistat-assisted weight loss in decreasing coronary heart disease risk in patients with X syndrome. Am J Cardiol 2001; 87: 827–31
Davidson MH, Hauptman J, DiGirolamo M, et al. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat. JAMA 1999; 281: 235–42
Zavoral JH. Treatment with orlistat reduces cardiovascular risk in obese patients. J Hypertension 1998; 16: 2013–7
Sjöstrom L, Rissanen A, Andersen T, et al. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998; 352: 167–72
Hollander PA, Elbein SC, Hirsch IB, et al. Role of orlistat in the treatment of obese patients with type 2 diabetes. Diabetes Care 1998; 21: 1288–94
Lindgarde F. The effect of orlistat on body weight and coronary heart disease risk profile in obese patients: the Swedish Multimorbidity Study. J Intern Med 2000; 248: 245–54
Miles JM, Leiter L, Hollander P, et al. Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin. Diabetes Care 2002; 25: 1123–8
Heymsfield SB, Segal KR, Hauptman J, et al. Effects of weight loss with orlistat on glucose tolerance and progression to type 2 diabetes in obese adults. Arch Intern Med 2000; 160: 1321–6
Snider LJ, Malone M. Orlistat use in type 2 diabetes. Ann Pharmacother 2002; 36: 1210–8
Halpern A, Mancini MC, Suplicy H, et al. Latin-American trial of orlistat for weight loss and improvement in glycemic profile in obese diabetic patients. Diabetes Obes Metab 2003; 5: 180–8
Hanefeld M, Sachse G. The effects of orlistat on body weight and glycaemic control in overweight patients with type 2 diabetes: a randomized, placebo-controlled trial. Diabetes Obes Metab 2002; 4: 415–22
Kelley DE, Bray GA, Pi-Sunyer FX, et al. Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: a 1-year randomized controlled trial. Diabetes Care 2002; 25: 1033–41
Jacob S, Gomis R, Miles JM. Effect of orlistat on glycemic control in patients on or near maximal doses of oral anti-diabetic (OAD) medications [abstract]. Diabetes 2002; 51Suppl. 2: A413
Deerochanawong C. Effect of treatment with orlistat in overweight or obese Thai patients with type 2 diabetes [abstract]. Diabetes 2001; 50Suppl. 2: A433
Bonnici F. Effect of orlistat on glycemic control and body weight in overweight or obese South African patients with type 2 diabetes [abstract]. Diabetes 2002; 51Suppl. 2: A412–3
DeFronzo R, Sjostrom L, Torgerson J, et al. XENDOS: onset of type 2 diabetes in obese patients with normal glucose tolerance, IGT and metabolic syndrome [abstract]. Diabetes 2003; 52Suppl. 1: A393
Torgerson JS, Boldrin MN, Hauptman J, et al. Xenical in the prevention of diabetes in obese subjects (XENDOS) study. Diabetes Care 2004; 27: 155–61
Garg A, Grundy SM. Diabetic dyslipidemia and its therapy. Diabetes Rev 1997; 5: 425–33
Johansen K. Efficacy of metformin in the treatment of NIDDM: meta-analysis. Diabetes Care 1999; 22: 33–7
UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854–65
Genuth S. Implications of the United Kingdom Prospective Diabetes Study for patients with obesity and type 2 diabetes. Obes Res 2000; 8: 198–201
Mäkimattila S, Nikkilä K, Yki-Järvinen H. Causes of weight gain during insulin therapy with and without metformin in patients with type II diabetes mellitus. Diabetologia 1999; 42: 406–12
Paolisso G, Amato R, Eccelente L, et al. Effects of metformin on food intake in obese subjects. Eur J Clin Invest 1998; 28: 441–6
Dulloo AG, Seydoux J, Girardier L. Potentiation of the thermogenic antiobesity effects of ephedrine by dietary methylxantines: adenosine antagonism or phosphodiesterase inhibition. Metabolism 1992; 41: 1233–41
Astrup A, Breum L, Toubro S, et al. The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet: a double blind trial. Int J Obes Relat Metab Disord 1992; 16: 269–77
Toubro S, Astrup AV, Breum L, et al. Safety and efficacy of long-term treatment with ephedrine, caffeine and an ephedrine/caffeine mixture. Int J Obes Relat Metab Disord 1993; 17Suppl. 1: S69–72
Rascovski A, Millner TH, Batalha L, et al. Eficácia e tolerabilidade das substâncias calorigênicas: ioimbina, triiodotironina, aminofilina combinada a efedrina e fenilpropanolamina no tratamento da obesidade a curto prazo. Arq Bras Endocrinol Metabol 2000; 44: 95–102
Mancini MC, Marsiaj HI, Hakoyama MM, et al. Ephedrine, caffeine and aminophilline preparation: an alternative in the treatment of obesity [abstract]. Int J Obes 1990; 14Suppl. 2: 141
Haller CA, Jacob P, Benowitz NL. Enhanced stimulant and metabolic effects of combined ephedrine and caffeine. Clin Pharmacol Ther 2004; 75: 259–73
Bray GA, Hollander P, Klein S, et al. A 6-month randomized, placebo-controlled, dose-ranging trial of topiramate for weight loss in obesity. Obes Res 2003; 11: 722–33
McElroy SL, Arnold LM, Shapira NA, et al. Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. Am J Psychiatry 2003; 160: 255–61
Kline KM, Carroll DG, Malnar KF. Painful diabetic peripheral neuropathy relieved with use of oral topiramate. South Med J 2003; 96: 602–5
Petit Jr WA, Upender RP. Medical evaluation and treatment of diabetic peripheral neuropathy. Clin Podiatr Med Surg 2003; 20: 671–88
Gadde KM, Franciscy DM, Wagner Jr HR, et al. Zonisamide for weight loss in obese adults: a randomized controlled trial. JAMA 2003; 289: 1820–5
Gadde KM, Parker CB, Maner LG, et al. Bupropion for weight loss: an investigation of efficacy and tolerability in overweight and obese women. Obes Res 2001; 9: 544–51
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Halpern, A., Mancini, M.C. Diabesity. Mol Diag Ther 4, 65–74 (2005). https://doi.org/10.2165/00024677-200504020-00001
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DOI: https://doi.org/10.2165/00024677-200504020-00001