Diabetes and a little about Anti-Infectives




The hypoglycaemic drug of choice in obese or overweight diabetics is metformin, because of its beneficial effect on insulin resistance. It can help patients lose weight, and bring about a reduction in all the risk factors associated with insulin resistance and metabolic syndrome.
Other hypoglycaemics, such as the sulphonylureas and glitazones, and even insulin, have weight gain as a side-effect. If such drugs are necessary for glycaemic control, patients should be warned of the deleterious effect on their weight, and weight management efforts redoubled.
Pharmacotherapy for obesity will often be appropriate for obese type 2 diabetics and has been shown to be successful in improving the markers of the condition. One study looked at obese patients with poorly controlled type 2 diabetes and concluded that:
Sibutramine produced statistically and clinically significant weight loss when used in combination with recommendations for moderate caloric restriction. This weight loss was associated with improvements in metabolic control and quality of life, and sibutramine was generally well tolerated in obese patients with type 2 diabetes.
In the Fujioki et al study, 33% of patients achieved weight loss of >5%, and 8% of patients achieved a weight loss of 10%. HbA1c was reduced by 0.53 and 1.65, respectively, in the 5 and 10% responders and fasting glucose dropped by 1.4 mmol/L and 3.8 mmol/L, respectively.
Orlistat was the subject of the XENDOS trial, which demonstrated that the risk of developing type 2 diabetes in obese subjects was 37% lower in people treated with orlistat when compared to lifestyle intervention alone, and patients treated with orlistat benefited from long-term improvements in cardiovascular risk factors such as blood pressure and lipid profiles.