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Weight gain seen with most diabetes drugs.

SAN DIEGO -- The real-world weight changes that occur in diabetic patients after the initiation of glucose-lowering medications generally mirror the weight changes that have been seen in carefully controlled clinical trials, Gregory A. Nichols, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.

Dr. Nichols presented data that were obtained from chart reviews that included 12,521 new diabetes drug initiations among 9,546 diabetic patients who were enrollees in Kaiser Permanente Northwest.

Analysis of the records revealed that patients typically gained about 2 pounds within a year of starting treatment with a sulfonylurea, 9 pounds after initiation of insulin therapy, and 11 pounds with thiazolidinedione treatment, said Dr. Nichols, of Kaiser Permanente's Center for Health Research, Portland, Ore.

With metformin, on the other hand, patients lost about 5 pounds. The differences between all of the groups were statistically significant.

"We make no value judgments about the drugs or their weight effects. Tight control, however achieved, is undoubtedly more important than any of the weight changes we observed," he said.

Age, sex, hemoglobin [A.sub.1c], history of peripheral arterial disease, use of selective serotonin reuptake inhibitors, and whether the agent was the first diabetes drug the patient had been treated with were all significant predictors of weight change.

However, adjusting for those and other demographic and clinical characteristics made little difference in the results, Dr. Nichols noted.

Although metformin has been increasingly used as first-line glucose-lowering therapy, sulfonylureas were still the most common first-line treatment (54%) among the 1,549 patients who were subsequently started on a second diabetes drug, he reported.

Weight changes with the addition of the second agent in this subgroup followed similar patterns. For example, the 833 in whom metformin was added to sulfonylurea first gained 6.4 pounds, then lost 5.6 pounds.

At the other extreme, the 26 patients in whom thiazolidinediones were added to insulin gained 14.7 pounds, then gained 11.2 more.


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Title Annotation:Endocrinology
Author:Tucker, Miriam E.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Jul 15, 2005
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