Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kelley, D. E.
Right arrow Articles by Kalhan, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kelley, D. E.
Right arrow Articles by Kalhan, S.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Diabetes Care 27:33-40, 2004
© 2004 by the American Diabetes Association, Inc.

Clinical Care/Education/Nutrition
Original Article

Effects of Moderate Weight Loss and Orlistat on Insulin Resistance, Regional Adiposity, and Fatty Acids in Type 2 Diabetes

David E. Kelley, MD1, Lewis H. Kuller, MD, DRPH2, Therese M. McKolanis, MPH1, Patricia Harper, MS, RD1, Juliet Mancino, MS, RD, CDE1 and Satish Kalhan, MD3

1 Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania
2 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
3 Schwartz Center and Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

Address correspondence and reprint requests to David E. Kelley, MD, Professor of Medicine, 810N Montefiore-University Hospital, University of Pittsburgh, 3459 Fifth Ave., Pittsburgh, PA 15213. E-mail: kelley{at}msx.dept-med.pitt.edu

OBJECTIVE—Moderate weight loss is recommended for overweight and obese patients with type 2 diabetes, and conjunctive use of weight loss medication has been advocated. The current study examined weight loss–dependent and –independent effects of the intestinal lipase inhibitor orlistat at 6 months of treatment, using behavioral intervention (Int) combined with randomized, double-blinded, placebo (P)-controlled treatment with orlistat (O).

RESEARCH DESIGN AND METHODS—Metabolic control, insulin sensitivity (IS), regional fat distribution, and fat content in liver and muscle were measured in 39 volunteers with type 2 diabetes in whom all antidiabetic medication was withdrawn 1 month preceding randomization. Weight loss was equivalent in the Int+O and Int+P groups, respectively (-10.3 ± 1.3 vs. -8.9 ± 1.1%), and there were identical decreases in visceral adipose tissue (VAT), fat mass (FM), thigh adiposity, and hepatic steatosis.

RESULTS—Weight loss resulted in substantial improvement (P < 0.001) in HbA1c (-1.6 ± 0.3 vs. -1.0 ± 0.4%; NS between groups). IS improved significantly more with orlistat ({Delta}2.2 ± 0.4 vs. {Delta}1.2 ± 0.4 mg · min-1 · kg-1 fat-free mass [FFM]; P < 0.05), and plasma free fatty acid (FFA) levels were strongly correlated with IS (r = 0.56; P < 0.001). Orlistat caused greater reductions in fasting plasma FFA ({Delta}–154 ± 22 vs. {Delta}–51 ± 33 µmol/l; P < 0.05), insulin-suppressed FFA ({Delta}–119 ± 23 vs. {Delta}–87 ± 34 µmol/l; P < 0.05), and fasting plasma glucose (FPG; -62 ± 9 vs. -32 ± 8 mg/dl; P = 0.02). Changes in HbA1c were correlated with {Delta}IS (r = -0.41; P < 0.01) but not with weight loss per se.

CONCLUSIONS—At equivalent weight loss, conjunctive use of orlistat resulted in greater improvement in FFA levels and IS.

Abbreviations: CT, computed tomography • EGP, endogenous glucose production • FFA, free fatty acid • FFM, fat-free mass • FM, fat mass • FPG, fasting plasma glucose • IS, insulin sensitivity • L/S ratio, liver-to-spleen ratio • SAT, subcutaneous adipose tissue • VAT, visceral adipose tissue


Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Eur J EndocrinolHome page
E. L Madsen, A. Rissanen, J. M Bruun, K. Skogstrand, S. Tonstad, D. M Hougaard, and B. Richelsen
Weight loss larger than 10% is needed for general improvement of levels of circulating adiponectin and markers of inflammation in obese subjects: a 3-year weight loss study
Eur. J. Endocrinol., February 1, 2008; 158(2): 179 - 187.
[Abstract] [Full Text] [PDF]

Home page
 ANGIOLOGYHome page
T. Tzotzas, M. Samara, T. Constantinidis, K. Tziomalos, and G. Krassas
Short-term Administration of Orlistat Reduced Daytime Triglyceridemia in Obese Women With the Metabolic Syndrome
Angiology, February 1, 2007; 58(1): 26 - 33.
[Abstract] [PDF]

Home page
 Diabetes CareHome page
E. Barinas-Mitchell, L. H. Kuller, K. Sutton-Tyrrell, R. Hegazi, P. Harper, J. Mancino, and D. E. Kelley
Effect of Weight Loss and Nutritional Intervention on Arterial Stiffness in Type 2 Diabetes
Diabetes Care, October 1, 2006; 29(10): 2218 - 2222.
[Abstract] [Full Text] [PDF]

Home page
 Diabetes CareHome page
F. G.S. Toledo, A. D. Sniderman, and D. E. Kelley
Influence of Hepatic Steatosis (Fatty Liver) on Severity and Composition of Dyslipidemia in Type 2 Diabetes
Diabetes Care, August 1, 2006; 29(8): 1845 - 1850.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
N. Finer
Does pharmacologically induced weight loss improve cardiovascular outcome? Impact of anti-obesity agents on cardiovascular risk factors
Eur. Heart J. Suppl., November 1, 2005; 7(suppl_L): L32 - L38.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 2004 by the American Diabetes Association.