Control In Obese Type Research Articles

Fasting plasma c-peptide level predicts the response of glucagon-like peptide-1 agonist (exenatide) add on to metformin monotherapy in obese type 2 diabetics

We aimed to evaluate the ability of serum C-peptide levels to predict glycemic control in obese type 2 diabetes (T2DM) patients in which a glucagon-like peptide-1 receptor agonist (GLP1-RA), an exenatide, was added to metformin monotherapy. This was a retrospective study, in which we enrolled 44 consecutives obese, type 2 diabetic patients receiving metformin monotherapy and have inadequate glycemic control (HbA1c >7% and <10%). Twice daily GLP1-RA (10 mcg exenatide injection) was added to the treatment. Weight, height and body mass index (BMI), in addition to fasting plasma glucose, hemoglobin A1c (HbA1c), and C-peptide levels measured baseline and at the sixth months post treatment. Regardless of the initial HbA1c level, treatment success was considered a HbA1c level below 7%. Predictors of successful glycemic control were assessed by a regression analysis. The fasting plasma C-peptide level was used as a marker of β cell function. After adding the GLP-1 RA, fasting glucose, C-peptide, BMI, and body weight decreased significantly (p < 0.01 for all). 27 (61.4%) patients were achieved treatment success, who have HbA1c level < 7% at the sixth month. The baseline C-peptide level was correlated with the HbA1c level 6 months post-treatment (r: 0.4, p: 0.01). Multivariate logistic regression analysis showed that the baseline fasting plasma C-peptide level was an independent predictor of successful glycemic control [exp.B: 6.6 (1.63-26-9) p: 0.008]. In a receiver operating characteristics (ROC) curve analysis, a baseline plasma C-peptide level of 2.56 ng/mL was the best cut-off value. Initial fasting plasma C-peptide levels can predict the treatment response of the GLP1-RA (exenatide 10 mcg, twice daily) add on to metformin monotherapy in obese type 2 diabetics.

Efficacy and safety of semaglutide in glycemic control, body weight management, lipid profiles and other biomarkers among obese type 2 diabetes patients initiated or switched to semaglutide from other GLP-1 receptor agonists

PurposeEvidence of the efficacy and safety of semaglutide among patients with type 2 diabetes who were initiated on or were switched to semaglutide from other GLP-1 RAs remains limited. The objective of this study was to investigate the short-term effects of switching to semaglutide from other GLP-1 RAs.MethodsThis retrospective cohort study evaluated patients with type 2 diabetes who were initiated on or were switched to semaglutide due to poor diabetes control with other GLP-1 RAs or other medications, or obesity. HbA1c, body weight, serum creatinine, serum uric acid, parameters of lipid metabolism, and parameters of liver function were measured before and 6 months after administration of semaglutide.ResultsA total of 50 patients were registered in the study. After switching to semaglutide (n = 43), HbA1c and body weight significantly decreased (p < 0.01, p < 0.01), respectively. The same findings were observed in semaglutide-naïve patients (p = 0.04, p < 0.02) (n = 7). Serum uric acid, total cholesterol, triglycerides, and urinary albumin-creatinine ratio decreased significantly as well (p = 0.04, p = 0.04, p = 0.02, p = 0.04), whereas serum creatinine did not change significantly (p = 0.51).ConclusionsSemaglutide showed excellent efficacy, even in patients switched from other GLP-1 RAs. Semaglutide appears to be a promising agent for blood glucose and body weight control in obese type 2 diabetes mellitus patients and could be more potent in treating type 2 diabetes than existing GLP-1 RAs.

Association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes.

Aims/IntroductionHigher hedonic hunger has been observed in obese individuals compared with those without obesity, but little is known about its association with glycemic management. We aimed to examine the association between hedonic hunger and glycemic control in non‐obese and obese patients with type 2 diabetes.Materials and MethodsBetween April and November 2016, a total of 211 type 2 diabetes patients who underwent comprehensive diabetes assessments at a university‐affiliated hospital were recruited into two groups according to body mass index: non‐obese (body mass index 18.5–24.9 kg/m2) and obese (body mass index ≥30 kg/m2) groups. All participants completed the Chinese version of the Power of Food Scale (PFS) for assessment of hedonic hunger. Good glycemic control was defined as glycated hemoglobin <7.0%.ResultsCompared with the non‐obese group, the obese group showed higher PFS aggregated and subscale ‘food available’ scores (both P < 0.05). After adjustment for age, sex, disease duration of diabetes and insulin use, there were positive associations of glycated hemoglobin with PFS aggregated, subscale ‘food available’ and ‘food present’ scores in the obese group (all P for trend <0.05). The PFS aggregated score was negatively associated with good glycemic control in obese type 2 diabetes patients after adjustment using logistic regression analysis (adjusted odds ratio 0.42, 95% confidence interval 0.20–0.91, P = 0.027). By contrast, such associations were not observed in non‐obese type 2 diabetes patients.ConclusionsHedonic hunger had an independent and inverse association with good glycemic control in obese Chinese patients with type 2 diabetes, but not in their counterparts without obesity.

The impact of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) on short term diabetic medication costs.

BackgroundType 2 diabetes mellitus (T2DM) has gained pandemic proportions becoming a global threat within the last few decades. In parallel to the increasing prevalence, healthcare costs have become a huge economic burden for the hospital and governments. Bariatric surgery has been proven to induce glycemic control in obese type 2 diabetics. However, the cost effectiveness of metabolic surgery in overweight, obese and morbidly obese individuals has not been documented. We aimed to demonstrate the efficacy and reduced diabetic-medication cost after diverted sleeve gastrectomy with ileal interposition (DSIT) in type 2 diabetic individuals followed more than 1 year.MethodsRecords of 116 type 2 diabetic patients operated by DSIT at a dedicated metabolic surgery clinic between October 2011 and April 2013 were retrospectively reviewed. A comparison was made between the annual diabetic medication cost before and after surgery using the paired t test. The alterations in BMI and HbA1c were recorded and analyzed.ResultsDiverted sleeve gastrectomy with ileal interposition led to a marked reduction in BMI and improved glycemic control after 1 year follow-up. Mean HbA1c levels decreased from a mean of 8.9 ± 1.7 to 6.6 ± 1.1 1 year after surgery (p < 0.001). Mean preoperative BMI declined from 32.9 ± 4.3 to 24.7 ± 2.7 kg/m2 (p < 0.001). Cost of diabetic medication decreased from a mean 660.08 USD/year to 65.12 USD 1 year after surgery (p < 0.001).ConclusionOur results have shown that DSIT operation leads to a significantly better glycemic control and lower diabetic medication costs at 1 year.

What is the impact of sleeve gastrectomy and gastric bypass on metabolic control of diabetes? A clinic-based cohort of Mediterranean diabetic patients

BackgroundEffectiveness of sleeve gastrectomy and gastric bypass on glycemic, blood pressure, and lipids control in obese type 2 diabetic patients is poorly known. ObjectiveTo assess the effectiveness of bariatric surgery on obese patients with type 2 diabetes. SettingUniversity hospital, Italy. MethodsDiabetes remission and metabolic changes over postoperative follow-up were assessed in 135 obese patients with type 2 diabetes who underwent bariatric surgery in 2007–2011 (gastric bypass, n = 100; sleeve gastrectomy, n = 35). Repeated-measures analysis of variance and logistic regression were used. ResultsDiabetes remission was observed in 22% and 21.5% of the patients, respectively, 1 and 2 years after surgery. Compared with the remaining patients, patients in diabetes remission were significantly younger, had lower diabetes duration, hemoglobin A1c (HbA1c), fasting plasma glucose, and frequency of insulin treatment. Trends of HbA1c, body mass index (BMI), blood pressure, and plasma triglycerides revealed a significant decrease over time and the trend of HDL-cholesterol revealed a significant increase over time in both treatment groups (P<.001). Patients reaching target levels for at least 3 out of 5 indicators of intermediate outcomes of care (composite indicator of good diabetes control) were 25.5% at the baseline and 66.1% at final follow-up visit (P<.001). In logistic regression, age (OR = .89, 95% CI .84–.95), HbA1c (OR = .67, 95% CI .49–0.91) and diabetes duration (OR = .87, 95% CI .77–1.00) were independent predictors of diabetes remission. ConclusionsBariatric surgery is an effective approach to optimize glucose, lipids, and blood pressure control in obese type 2 diabetic patients. Bariatric surgery should be offered earlier over the natural course of diabetes to increase the likelihood of diabetes remission in obese patients.

Lorcaserin

Lorcaserin

Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients

BackgroundThe Korean National Health and Nutrition Examination Surveys reported 65% of daily energy intake (EI) as carbohydrate (CHO) in the Korean population and main source of CHO was cooked rice. We used a standardized-small sized rice bowl for diet education and investigated its effectiveness on body weight, glucose and lipid, compared to the conventional food exchange system in type 2 diabetes obese women.MethodsType 2 diabetic women with body mass index ≥ 23 kg/m2 were randomly assigned to small rice bowl-based meal plan (BM) and food exchange-based meal plan (ExM) group. Both groups were asked to reduce their EI by 500 kcal/day for 12 weeks. The macronutrient composition was instructed: 55 to 60% of EI as CHO, 15 to 20% as protein, and 20 to 25% as fat. BM group received only a simple instruction for application of the rice bowl. Nutrient intake was estimated with the 3-day dietary records.ResultsFinally, 44 subjects finished the study. The percent reduction of body weight was significant both BM group (-5.1 ± 2.6%) and ExM group (-4.8 ± 2.8%) after 12 weeks (P < 0.001) but there was no difference between the groups. There was no difference in the proportional change of CHO, protein and fat in EI between the groups. Additionally, the change of HbA1c and low density lipoprotein-cholesterol were not significantly different between the two groups.ConclusionThe BM group was as effective as ExM for body weight and glucose control in type 2 diabetes obese women.

Improvement in Glycemic Control in Morbidly Obese Type 2 Diabetic Subjects by Gastric Stimulation

Gastric electrical stimulation synchronized to the refractory period of gastric electrical activity and applied during meals was evaluated for safety and for improvement of body weight and glycemic control in obese type 2 diabetes. The study involved obese diabetic type 2 (ODM) patients in a multicenter open-label European feasibility trial. A total of 24 ODM (nine males, 15 females) treated with insulin and/or oral hyperglycemic agents and body mass index between 33.3 to 49.7 kg/m(2) were implanted laparoscopically with a TANTALUS system. There were 18 adverse events related to the implant procedure or the device reported in 12 subjects. All were short lived and resolved with no sequelae. In the 21 subjects that reached the 1-year visit weight was reduced by 4.5 +/- 2.7 kg (p < 0.05) and HbA1c by 0.5 +/- 0.3% (p < 0.05). In a subgroup (n = 11) on stable or reduced oral medication, weight was reduced by 6.3 +/- 3.4 kg (p < 0.05) and HbA1c by 0.9 +/- 0.4% (p < 0.05). The group on insulin (n = 6) had no significant changes in weight and HbA1c. The TANTALUS system is well tolerated in obese type 2 diabetic subjects. Gastric electrical stimulation can potentially improve glucose metabolism and induce weight loss in obese diabetic patients, who are not well controlled on oral antidiabetic therapy. Further evaluation is required to determine whether this effect is due to induced weight loss and/or to direct signal dependent mechanisms.

Low Intensity Exercise Is Equally Effective As High Intensity Exercise Training To Improve Glycemic Control In Obese Type 2 Diabetes Patients

Low Intensity Exercise Is Equally Effective As High Intensity Exercise Training To Improve Glycemic Control In Obese Type 2 Diabetes Patients

The effect of a rapid weight loss on lipid profile and glycemic control in obese type 2 diabetic patients.

To test the effect of low calorie diet (LCD) on body weight, lipid profile, and glycemic control in obese type 2 diabetes mellitus (DM) patients. Dietary intervention. Department of Human Nutrition, Copenhagen. Outpatients: 11 type 2 DM patients (three males/eight females) (10 completed), four on oral hypoglycemic agents (OHA). Body mass index (BMI) 36.8 +/- 5.5 kg/m2 and age 62 +/- 5.7 y. In all, 8 weeks full meal-replacement diet: eight sachets of a nutrition powder (Nutrilett, 850 kcal/day). Lipid profile assessed by NMR spectroscopy. Mean body weight fell by 10.9 kg (approximately 11%, P<0.001). Fasting insulin, fasting blood glucose, hemoglobin A1c, fasting plasma triglycerides, total cholesterol, and low-density lipoprotein (LDL) cholesterol fell significantly. There were large positive changes (statistically insignificant) in LDL subclass distribution and a similar shift in high-density lipoprotein subclass distribution. Medication was discontinued in all four subjects taking OHA for 2 weeks prior to the intervention and throughout the whole 8-week intervention period. LCD is effective in improving glycemic control and blood lipids through weight loss in overweight type 2 DM patients.

Antiobesity pharmacotherapy in the management of type 2 diabetes.

Obesity is a well-known risk factor for the development of Type 2 diabetes mellitus. The management of the obese diabetic patient remains a challenge for the clinician but, in any case, weight reduction should be considered as a key objective. In this respect, several antiobesity drugs have demonstrated potential. However, while fenfluramine and dexfenfluramine have been shown to promote weight loss and to directly improve insulin sensitivity, being two mechanisms contributing to better blood glucose control in obese Type 2 diabetic patients, they were recently withdrawn due to safety problems. Sibutramine, a new selective norepinephrine and serotonin reuptake inhibitor, promotes weight loss by decreasing food intake, an effect which leads to a mild improvement (significant in patients losing > or =5% of initial body weight) of blood glucose control in obese diabetic patients. Similarly, orlistat, a selective gastrointestinal lipase inhibitor which increases faecal fat losses, enhances diet-induced weight reduction and improves both blood glucose control and vascular risk profile, especially dyslipidaemia, in obese Type 2 diabetic patients. Further studies are required to better identify good responders to pharmacotherapy and specify the role of antiobesity agents in the overall long-term management of obese subjects with Type 2 diabetes. Other novel pharmacological approaches deserve further consideration, for instance beta-3 agonists aiming to increase energy expenditure, drugs interfering with tumor necrosis factor-alpha (TNF-alpha) or free fatty acid release by the adipose tissue or agents that slow gastric emptying. However, until now, results regarding efficacy and/or safety have been disappointing or preliminary in humans.

Effect of metformin on glycaemic control in type 2 diabetes in daily practice: a retrospective study

Introduction. Recently the UKPDS study revealed the potency of metformin therapy in obese type 2 diabetic patients. A retrospective study was performed to assess the efficacy of metformin therapy in improving metabolic control in everyday practice.Patients and methods. Type 2 diabetic patients were included if they met the following criteria: metformin had been added when the previous treatment failed to optimise glycaemic control expressed in HbA1c level; duration of metformin therapy had to be at least six months. Efficacy of metformin therapy, expressed as a decrease in HbA1c, was measured with a median follow-up of 32 (range 6–60) months. Variables were analysed using a paired t-test.Results. One hundred and sixty-three patients were treated with metformin. 98 patients were excluded, because of absence of an HbA1c value prior to treatment with metformin mainly (n=78). The mean HbA1c of included patients had decrerased 1.4% (p<0.001) after 6 months (n=65), 1.6% (p<0.001) after 24 months (n=45) and 1.5 (p<0.001) after 36 months (n=28). During follow-up there was no significant weight gain or loss.Conclusion. Metformin can be considered an effective treatment to improve glycaemic control in obese type 2 diabetic patients.

New agents for Type 2 diabetes.

Current agents for the treatment of Type 2 diabetes mellitus improve the metabolic profile but do not reinstate normality. They also reduce chronic diabetic complications, but they do not eliminate them. Thus, new agents with novel actions are required to complement and extend the capabilities of existing treatments. Insulin resistance and beta-cell failure, which are crucial components in the pathogenesis of Type 2 diabetes, remain the underlying targets for new drugs. Recently introduced agents include a short-acting non-sulphonylurea insulin-releaser, repaglinide, which synchronizes insulin secretion with meal digestion in order to reduce post-prandial hyperglycaemia. The thiazolidinedione drugs, troglitazone, rosiglitazone and pioglitazone represent a new class of agonists for the nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARgamma). PPARgamma increases the transcription of certain insulin-sensitive genes, thereby improving insulin sensitivity. The intestinal lipase inhibitor orlistat and the satiety-inducer sibutramine are new weight-reducing agents that may benefit glycaemic control in obese Type 2 diabetes patients. Several further new insulin-releasing agents, and agents to retard carbohydrate digestion and modify lipid metabolism stand poised to enter the market. The extent to which they will benefit glycaemic control remains to be seen. However, the prospect of permanently arresting or reversing the progressive deterioration of Type 2 diabetes continues to evade therapeutic capture.

The impact of pharmacotherapy on weight management in type 2 diabetes.

Today, obesity is the most important modifiable risk factor for type 2 diabetes. An excess of body fat is associated with a deterioration of glucose utilisation and promotes the development of type 2 diabetes, particularly in those with a genetic predisposition for the disease. It is also well established that a reduction of excess body fat improves insulin sensitivity and can prevent the conversion to diabetes. In those with overt diabetes, weight loss usually ameliorates glycaemic control and associated metabolic disturbances. Among the pharmacological agents that are used for the treatment of type 2 diabetes only metformin has a weak weight-lowering activity and is considered as the drug of choice for adjunct pharmacotherapy in obese diabetic subjects. A few studies also suggest that acarbose can induce a modest weight reduction in such patients. In contrast, sulphonylurea and insulin treatment is frequently accompanied by substantial weight gain which should be taken into consideration when these drugs are used. Another approach to improve metabolic control in obese type 2 diabetic patients is the use of weight-lowering agents. The new serotonin and noradrenaline reuptake inhibitor sibutramine promotes weight loss which subsequently leads to improved glycaemic control. Orlistat, a lipase inhibitor, is also able to ameliorate metabolic control in such patients due to its weight-lowering potential. As obesity remains a therapeutic challenge in most type 2 diabetic subjects, weight management drugs may represent an alternative or supplement to antidiabetic agents. Moreover, weight management agents have the advantage that they have additional favourable effects on associated cardiovascular risk factors.

Addition of Benfluorex to Biguanide Improves Glycemic Control in Obese Non–Insulin-Dependent Diabetes: A Double-Blind Study versus Placebo

The oral antidiabetic benfluorex lowers insulin resistance in liver and muscle without stimulating insulin secretion; it is more effective than a biguanide in lowering insulin and triglyceride levels and does not elevate lactate. This double-blind multicenter community study compared the addition of benfluorex versus placebo to diet plus metformin in 127 uncontrolled obese type II diabetics. After a 2-month run-in on diet plus metformin, overall mean glucose was 7.7 mmol/L or greater (fasting) and/or 11 mmol/L or greater (2 h after 75-g oral glucose), with 20% or greater excess body weight [body-mass index (women/men): ⩾ 26.9/⩾ 27.2 kg/m 2). Patients were then randomized to adjuvant benflouorex ( n = 63; 150 mg t.i.d.) or placebo ( n = 64) for 90 days, with centralized biochemical monitoring. On benfluorex, glucose decreased from day 0 to day 90 (fasting: 8.99 ± 2.76 to 7.81 ± 2.32 mmol/L, p = 0.002; 2 h post-load: 16.56 ± 4.49 to 15.09 ± 5.09 mmol/L, p = 0.029) versus increases on placebo (intergroup p = 0.003 and p = 0.001, respectively). HbA decreased on benfluorex (7.47 ± 1.44 to 7.12 ± 1.13%; p = 0.013) versus no change on placebo. Basal and stimulated insulin and C peptide did not change in either group. Body weight remained similar in both groups. Tolerability was good in both groups, with no increase in hypoglycemia on benfluorex. Adjuvant behfluorex improves glycemic control in obese type II diabetics uncontrolled by diet plus metformin. The combination is safe, well- tolerated and suitable for introduction into routine practice.

Dexfenfluramine in Type II diabetes: effect on weight and diabetes control

Objective To assess the effect of dexfenfluramine on weight loss, diabetic control and blood lipids in type II diabetics over a three-month period. Design, setting and patients: Forty overweight patients in the Diabetic Clinic, Fremantle Hospital, were studied in a double-blind, placebo-controlled trial with a run-in period of one month followed by three months on either dexfenfluramine or placebo. Main outcome measures: Changes in body weight, and fasting plasma glucose, glycosylated haemoglobin, plasma cholesterol and triglyceride levels. Main results: The median change in weight was -3.8 kg in the treatment group (Df) and +0.3 kg in the placebo group (PI) (P = 0.006). The median changes in fasting plasma glucose levels were -1.0 mmol/L (Df) and +0.6 mmol/L (PI) P =0.010). The median changes in glycosylated haemoglobin levels were -1.4% (Df) and +0.2% (PI) (P = 0.002). The median changes in triglyceride levels were -0.3 mmol/L (Df) and +0.2 mmol/L (PI) (P = 0.017). Cholesterol level did not change significantly. Conclusion: Dexfenfluramine is effective in achieving weight loss and also improved diabetic control in obese type II diabetics over a three-month period.

Very-low-calorie diet for obese type 2 diabetic patients

Source Citation Wing RR, Marcus MD, Salata R, et al. Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects. Arch Intern Med. 1991 Jul;151:1334-40.

Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects

Effects of a very-low-calorie diet on long-term glycemic control in obese type 2 diabetic subjects

Effects of a Very-Low-Calorie Diet on Long-term Glycemic Control in Obese Type 2 Diabetic Subjects

We tested the hypothesis that the use of a very-low-calorie diet (VLCD) in combination with behavior modification would promote long-term glycemic control in obese type 2 diabetic subjects. Thirty-six diabetic subjects were randomly assigned to a standard behavior therapy program or to a behavior therapy program that included an 8-week period of VLCD. The behavior therapy group consumed a balanced diet of 4200 to 6300 J/d throughout the 20-week program. The VLCD group consumed a balanced diet of 4200 to 6300 J for weeks 1 to 4, followed by a VLCD (1680 J/d of lean meat, fish, and fowl) for weeks 5 to 12. The VLCD group then gradually reintroduced other foods during weeks 13 to 16 and consumed a balanced diet of 4200 to 6300 J/d for weeks 17 to 20. Thirty-three of the 36 subjects completed the 20-week program and the 1-year follow-up. Use of the VLCD produced greater decreases in fasting glucose at the end of the 20-week program and at 1-year follow-up and greater long-term reductions in HbA1. The VLCD group also had greater weight losses at week 20, but weight losses from pretreatment to 1-year follow-up were similar in the two treatment groups. The improved glycemic control with the VLCD appeared to be due to increased insulin secretion, but further research is needed to confirm this.