Effects of Dietary Treatment Alone or Diet With Voglibose or Glyburide on Abdominal Adipose Tissue and Metabolic Abnormalities in Patients With Newly Diagnosed Type 2 Diabetes

Abstract

OBJECTIVE—To examine the effects of diet and diet with voglibose or glyburide on abdominal adiposity and metabolic abnormalities in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A total of 36 Japanese patients with newly diagnosed type 2 diabetes (50.8 ± 8.6 years of age, BMI 24.5 ± 3.5 kg/m²) and 273 normal control subjects were studied. The patients were treated for 3 months with diet alone (30 kcal/kg per day) (n = 15), diet with voglibose (n = 12), or diet with glyburide (n = 9). They underwent 75-g oral glucose tolerance testing, assessment of insulin sensitivity (SI), and acute insulin response (AIR) with intravenous glucose tolerance testing based on the minimal model, and measurement of abdominal visceral adipose tissue area (VAT) and subcutaneous adipose tissue area (SAT) by computed tomography before and after treatment.

RESULTS—The diabetic patients had comparable SAT but larger VAT than the control subjects. With a mean weight loss of 2–3 kg, VAT and SAT were decreased similarly in all treatment groups. The VAT-to-SAT ratio was decreased only in the voglibose group. Glycemic control and serum lipid profiles were improved in all groups. Changes in glycemic control after diet were closely correlated with changes in VAT but not with changes in SAT. SI and AIR were unchanged in the diet group but were improved in the voglibose and glyburide groups.

CONCLUSIONS—In Japanese patients with newly diagnosed type 2 diabetes who were relatively lean but had excess VAT, diet with or without voglibose or glyburide effectively reduced VAT. Decrease in VAT was closely associated with improvement of glycemic control with diet. Additional use of voglibose or low-dose glyburide had no detrimental effects on abdominal adiposity and had beneficial effects on SI and AIR.