Abstract
Background and AimIntentional weight loss, primarily by improving insulin resistance, is known to decrease the need for anti-diabetic medications. In this study, we assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment.MethodsCase records of 50 overweight or obese patients with DM who successfully decreased dosage or discontinued diabetes medications after losing weight via attendance at two University-based, outpatient weight management centers were analyzed. Follow-up visits, weight reduction interventions, and decisions for dose reductions or discontinuation of medications were individualized to patient needs by the treating physician.ResultsMean starting BMI was 35 kg/m2, mean age 53.4 years, and 58% were male. All 50 used at least one anti-diabetic medication (30 metformin, 39 sulfonylureas, 31 insulin, 21 sitagliptin) to manage blood sugar. Mean duration of follow-up was 30.2 months. Mean weight loss was 10.8±4.1 kgs (11.1% of initial body weight ±4.7%). 22/50 patients (44%) discontinued anti-diabetes medications (14 sulfonylureas [36%], 7 insulin [23%], 4 sitagliptin [19%]). The mean percentage weight loss achieved at the point of successful discontinuation of medication was 11.2%±3.5% (14% for sulphonylureas, 11% for insulin, and 7.1% for sitagliptin). Mean percentage weight loss of 5.6%±2.8% (5.1% for sulphonylureas, 4.3% for insulin, and 7.1% for sitagliptin) was required for initial dose reduction. For every 5% weight loss, predicted dose reductions were sulphonylureas, 39%; insulin, 42%; and any anti-diabetic medications, 49%.ConclusionAmong overweight or obese patients with type 2 diabetes, intentional weight loss of 7–14% was typically required for full discontinuation of at least one anti-diabetic medication. Discontinuation of insulin was achieved at a mean weight reduction of 11% of initial body weight.
Highlights
National survey data for 2007–2008 indicate that 33.8% of US adults are obese [body mass index (BMI; calculated as weight in kilograms divided by height in meters squared)$30], and the combined prevalence of overweight and obesity is reported to be 68% [1]
In this study of overweight and obese patients from two University-based weight management clinics, we studied the association between the percentage of weight loss and dose reductions or discontinuation of anti-diabetic medications
Four more were excluded due to physical limitations that prevented adherence to the prescribed physical activity. 3 more were excluded because, though they were diabetic and successfully lost weight, they were unsuccessful in dose reductions of antidiabetic medications. 7 more were excluded because, though diabetic, they neither lost weight nor were successful in reducing anti-diabetic medications
Summary
National survey data for 2007–2008 indicate that 33.8% of US adults are obese [body mass index (BMI; calculated as weight in kilograms divided by height in meters squared)$30], and the combined prevalence of overweight and obesity is reported to be 68% [1]. Data from the Behavioral Risk Factor Surveillance System showed that overweight (BMI 25–29.9), obese (BMI 30–39.9), and morbidly obese (BMI$40) US adults had 1.59, 3.44 and 7.37 times higher odds, respectively, of diagnosed DM, compared to those with normal BMI (BMI 18.5–25) [3]. We assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment
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