Pharmacologic induction of weight loss to treat type 2 diabetes
- PMID: 10372238
- DOI: 10.2337/diacare.22.6.896
Pharmacologic induction of weight loss to treat type 2 diabetes
Abstract
Objective: Most individuals with type 2 diabetes are overweight, and weight loss for them is an important therapeutic objective. However, usual weight-loss strategies have generally not produced sustained weight loss. Pharmacologic agents to assist weight loss might be useful, but no long-term data on their effectiveness and safety in patients with type 2 diabetes are available. We therefore initiated a 2-year placebo-controlled trial of the weight-loss medications fenfluramine and phentermine in type 2 diabetic subjects.
Research design and methods: A total of 44 overweight (> 120% ideal body weight) subjects with type 2 diabetes were enrolled in a randomized, placebo-controlled, double-blind trial of fenfluramine and phentermine. All subjects received intensive nutrition counseling, an exercise prescription, and instruction in behavior modification. Subjects were randomly assigned to 20 mg fenfluramine three times a day and 37.5 mg phentermine daily (n = 23) or dual placebos (n = 21). Diabetes medications were adjusted as necessary to achieve glycemic goals. Changes in weight, glycemia, lipemia, and blood pressure were assessed every 2 months, as were adverse events. In September 1997, when fenfluramine was withdrawn from the U.S. market, fenfluramine was stopped in all subjects. Thus the length of drug treatment varied, but 16 subjects (8 in each group) reached 12 months of treatment. Only data obtained before the withdrawal of fenfluramine are included in this report.
Results: A study termination, diabetes medications had been reduced in 1 subject in the placebo group (5%) and 11 subjects in the drug treatment group (52%) (P = 0.005). Drug treatment resulted in significant reductions in body weight, BMI, and HbA1c at all time points through 6 months. Changes in weight at 6 months were -2.7 +/- 1.4 kg (mean +/- SEM) with placebo treatment and -9.6 +/- 1.5 kg with drug treatment (P = 0.003). Even though more subjects in the drug treatment group required reductions in diabetes medications, at 6 months, changes in HbA1c were -0.3 +/- 0.2% with placebo treatment and -1.6 +/- 0.3% with drug treatment (P = 0.002). Fasting plasma glucose and triglycerides were significantly reduced at some time points with drug treatment. No serious adverse events attributable to study medications were observed.
Conclusions: Premature study termination decreased the power of our study at later time points. However, our data suggest that weight loss medications are an effective treatment for type 2 diabetes during active weight loss. Whether the benefit persists after weight loss has stopped remains to be determined.
Similar articles
-
Dexfenfluramine in obese Chinese NIDDM patients. A placebo-controlled investigation of the effects on body weight, glycemic control, and cardiovascular risk factors.Diabetes Care. 1997 Jul;20(7):1122-7. doi: 10.2337/diacare.20.7.1122. Diabetes Care. 1997. PMID: 9203448 Clinical Trial.
-
Long-term weight control study. I (weeks 0 to 34). The enhancement of behavior modification, caloric restriction, and exercise by fenfluramine plus phentermine versus placebo.Clin Pharmacol Ther. 1992 May;51(5):586-94. doi: 10.1038/clpt.1992.69. Clin Pharmacol Ther. 1992. PMID: 1587072 Clinical Trial.
-
Long-term drug treatment of obesity in a private practice setting.Obes Res. 1997 Nov;5(6):578-86. doi: 10.1002/j.1550-8528.1997.tb00579.x. Obes Res. 1997. PMID: 9449143
-
Dexfenfluramine, fenfluramine, and phentermine for the treatment of morbid obesity.J Am Acad Nurse Pract. 1997 Aug;9(8):389-94, quiz 395-7. doi: 10.1111/j.1745-7599.1997.tb01261.x. J Am Acad Nurse Pract. 1997. PMID: 9325813 Review. No abstract available.
-
Antiobesity pharmacotherapy in the management of type 2 diabetes.Diabetes Metab Res Rev. 2000 Mar-Apr;16(2):114-24. doi: 10.1002/(sici)1520-7560(200003/04)16:2<114::aid-dmrr97>3.0.co;2-o. Diabetes Metab Res Rev. 2000. PMID: 10751751 Review.
Cited by
-
Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients?J Gastrointest Surg. 2005 Nov;9(8):1112-6; discussion 1117-8. doi: 10.1016/j.gassur.2005.07.016. J Gastrointest Surg. 2005. PMID: 16269382
-
Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.Ann Surg. 2003 Oct;238(4):467-84; discussion 84-5. doi: 10.1097/01.sla.0000089851.41115.1b. Ann Surg. 2003. PMID: 14530719 Free PMC article.
-
Current management strategies for coexisting diabetes mellitus and obesity.Drugs. 2003;63(12):1165-84. doi: 10.2165/00003495-200363120-00001. Drugs. 2003. PMID: 12790691 Review.
-
Chronic treatment with either dexfenfluramine or sibutramine in diet-switched diet-induced obese mice.Endocrine. 2006 Apr;29(2):375-81. doi: 10.1385/ENDO:29:2:375. Endocrine. 2006. PMID: 16785615
-
Luseogliflozin Persistently Lowers Glycemia and Body Weight Over a Period of Two Years in Patients With Type 2 Diabetes.Cureus. 2025 Feb 4;17(2):e78503. doi: 10.7759/cureus.78503. eCollection 2025 Feb. Cureus. 2025. PMID: 40062137 Free PMC article.