Issue 171 Item 10 Multi-Pronged Approach Reduces Weight, Lowers Glycemia in Diab

Combining several weight loss approaches leads to greater weight loss and improved glycemic control compared with a standard weight loss program for type 2 diabetics.

"Weight loss may be the single most important therapeutic objective" for the 80% of diabetics who are overweight or obese, Dr. J. Bruce Redmon and colleagues write in the September issue of Diabetes Care. However, standard weight loss programs have not proven very effective.

Therefore, the Minneapolis-based research team combined intermittent low-calorie diets, energy-controlled meal replacements, and sibutramine in one arm of a prospective trial. The Slim Fast Foods Company provided meal replacement products and snack bars.
Twenty-nine subjects were randomly assigned to standard therapy, which included education, counseling and individualized exercise and diet prescriptions.

The 30 subjects in the combination therapy group received standard therapy, as well as 10-15 mg sibutramine daily and meal replacement products for 1 week every 2 months. Between low-calorie diet weeks, subjects were given one meal replacement product and one snack bar daily to replace one usual meal and snack.

At 1 year, the combination therapy group lost significantly more weight, average 7.3 kg, compared with the control group, 0.8 kg (p < 0.001).

Mean HbA1c values had also decreased significantly by 0.6 in the combination treatment group, whereas values were the same as baseline in the standard group. Moreover, seven combination patients and one standard patient required less diabetes medication, and four and 16, respectively, required more medications.

Even though the replacement meals and snacks are high in sugar and other carbohydrates, the research team observed no problems with hyperglycemia, hypoglycemia or electrolyte imbalances.
Diabetes Care 2003;26:2505-2511.

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