Insuline et prise de poids

Abstract

Insulin therapy is a key for type 1 and of type 2 diabetic patients management. As demonstrated by the DCCT and the UKPDS studies, insulin therapy promotes a good metabolic control and reduces microvascular complications in both populations. Body weight increase after insulin therapy initiation may be a barrier to initiation or to intensification of insulin therapy. The body weight increase (around 2.5 kg in type 1 diabetic patient and around 6 kg in type 2 diabetic patient) reach its maximal level during the first 12 months following insulin therapy initiation. The analysis of body composition modifications showed that insulin increases fat mass and lean mass in both type 1 and type 2 diabetic patients to a level similar at what observed before the clinical onset of diabetes. In type 2 diabetic population, the body weight increase after insulin therapy initiation is correlated with the maximal body weight observed in the life. These results suggested that weight gain during insulin therapy is a “catch-up” weight regain. Insulin increases body weight by reducing glycosuria and by reducing neoglucogenesis and various cost expensive metabolic cycles usually observed in hyperglycemic patients. Positive nitrogen balance following insulin therapy promotes lean mass increase. No deleterious effect of weight gain during insulin therapy has been reported in the literature on cardiovascular events in both type 1 (DCCT/EDIC study) and in type 2 diabetic patients (UKPDS study). The association with metformin is recommended to reduce weight gain following insulin therapy. The development of a new basal analogue insulin with preferential hepatic action than peripheral action will favour weight stability resulting in immediate and long-term benefits for patients.