Issue 107 Item 10 Efficacy of Orlistat in Overweight Patients With Insulin-Treat

Weight loss improves glycemic control, lipid profiles, and blood pressure in patients with type 2 diabetes. >However, successful long-term weight loss is difficult for these patients, particularly those treated with insulin. The aim of this study was to assess the effect of orlistat, a gastrointestinal lipase inhibitor, on weight loss, glycemic control, and cardiovascular risk factors in overweight or obese insulin-treated type 2 diabetic patients.

This study was a 1-year multicenter, randomized, double-blind, placebo-controlled trial of orlistat (120 mg three times a day) or placebo combined with a reduced-calorie diet in overweight or obese adults (BMI 28–40 kg/m2) with type 2 diabetes treated with insulin alone or combined with oral agents, but with suboptimal metabolic control (HbA1c 7.5–12.0%). Outcome measurements included changes in body weight, glycemic control, blood pressure, and serum lipids.

After 1 year, the orlistat group lost significantly more weight than the placebo group. Orlistat treatment, compared with placebo, produced greater decreases in HbA1c, fasting serum glucose (-1.63 ± 0.3 vs. -1.08 ± 0.3 mmol/l, P = 0.02), and the required doses of insulin and other diabetic medications. Orlistat also produced greater improvements than placebo in serum total cholesteroland LDL cholesterol concentrations and LDL/HDL ratio.

The results of the study showed that Orlistat therapy produces clinically significant weight loss, with improvements in glycemic control and cardiovascular disease risk factors, in overweight or obese patients with type 2 diabetes who have suboptimal metabolic control with insulin therapy. Diabetes Care 25: 1033-1041.