Posts Tagged ‘Meridia’
Drug Treatment of Overweight Diabetics
Obesity Overview
Obesity is now looked at as being a long-term energy storage disease. Over the last 200 years there has been a progressive increase in the size and height of humans, while before that time, height had remained stable. Since the availability and balance of energy affects growth, the overall greater availability of calories has in large part resulted in this increase in the stature of mankind. However, as lifespan has progressively increased (from about 40 years in 1890 to 50 years in 1960 and to about 80 years today), this “extra time” has given people more leisure time. Unfortunately, we have not been particularly good at using this time effectively in terms of exercise. Rather, we have become more sedate as a species. This is reflected in the trend toward increasing weight as we age. For example, in 1960, about 25% of men and women were considered to be “obese” and that number has risen to 33% today.
One measure of how large we are is the Body Mass Index (BMI); when a persons BMI is very high (usually over a value of 25-26kg/m2), that person’s risk of developing serious weight- related illnesses (such as heart disease and diabetes) and of dying prematurely from these illnesses, is increased.
BMI is calculated by taking a person's weight in kg (kg = pounds/2.2) and dividing by the person's height in meters (meters = inches x 0.0254), squared.
One way to cut the risk of illness from weight-related conditions is to maintain an ideal body weight. Weight reduction has physiologic benefits that improve our overall health status, but as anyone who has ever dieted knows, it is very difficult to “normalize” body weight, and this is especially difficult in persons with long-standing obesity. Therefore, experts are now looking into the benefits of modest weight loss (10-15% of body weight) by adjusting the balance of caloric intake and caloric loss. By taking in only as many calories as are required to maintain a normal body weight, there is little chance of becoming overweight. The strategies used to maintain this caloric balance are varied and include behavior modification, diets, appetite suppressants, exercise, thermogenic drugs and in severe cases of obesity, surgery. For example, one Swedish study found that a 28kg loss in body weight resulted in a 32- fold decrease in the risk for developing diabetes.
Pharmacologic Agents in Managing Diabetes
Many experts now consider being overweight as being in a pre-diabetic stage. Once above the normal Body Mass Index (BMI) rate of 25 kg/m2, the overall risk for developing diabetes and for dying prematurely increases. For example, a person with a BMI of 30 kg/m2 has a 20 times greater risk of developing diabetes than if their BMI were 25. As BMI increases, insulin sensitivity drops dramatically causing an increase in insulin levels and a subsequent increase in fat stores in the gut (also called visceral adipose tissue). It is known that if you lose 10% of body weight, you will lose 1/3 of your visceral fat. Even small amounts of weight loss will have beneficial effects because the intra-abdominal fat is greatly reduced.
A number of new drugs are being used and developed for the management of obesity. Among the most popular of the newer agents is Redux (dexfenfluramine). In one typical study, after 1 year use of Redux, 52% of patients lost more than 10% of body weight and 72% lost at least 5% body weight. Only 30% of patients using placebo lost more than 10% and only 64% of placebo-treated patients lost greater than or equal to 5%. The investigators found that if a person lost more than 4 lb. during the first month of treatment, they had more than a 75% chance of losing more than 10% of their body weight over the next year. This reduction in weight also helped to decrease HbA1c (hemoglobin A1C) levels indicating that blood sugar control was improved as weight reduction occurred.
Sibutramine (Meridia) blocks the reuptake of norepinephrine and serotonin and had similar results to Redux in one study; about 50% of patients lost 10% of body weight after one year. Those who lost the most weight, also had the greatest reduction in HbA1c levels. Sibutramine also causes a decrease in total glucose level.
Orlistat (Xenical) is a new drug that is a pancreatic lipase inhibitor; it causes a 35% inhibition of fat absorption and is correlated with a slight decrease in HbA1c and LDL cholesterol levels. Given during meals, it is well tolerated. When used with a low-calorie diet, patients lost 10% of body weight as compared to 6% among those treated with placebo and patients gained back less weight over the next year when diet was liberalized.