Antidiabetic Drugs And Body Weight

It has long been recognized that antidiabetic drugs can promote weight gain in subjects with type 2 diabetes. The strongest weight-promoting effect is exerted by insulin. In the diabetes control and complications trial (DCCT), intensified insulin treatment was associated with substantial weight gain that resulted in unfavorable changes of lipid levels and blood pressure similar to those seen in the insulin resistance syndrome (24). In the UKPDS, insulin treatment caused a mean weight gain of approximately 7 kg over 12 years of treatment in newly diagnosed subjects with type 2 diabetes (25). In addition, sulfonylureas are known to promote weight gain due to their insulin-secretory action. In the UKPDS, the average weight gain under glibenclamide treatment amounted to about 5 kg (25). It was repeatedly reported that PRARy-agonists lead to weight gain. However, this weight gain occurs mainly in the subcutaneous depots, but not in the visceral depot that may have less deleterious metabolic consequences (26). In the recently published ADOPT study treatment with rosiglitazone over 5 years was followed by a mean body weight increase of 4.8 kg. This weight gain was not associated with an increase in the waist/hip ratio indicating that the expansion of adipose tissue occurred largely in the subcutaneous depots (27). In the same trial, monotherapy with glibenclamide resulted in a mean weight gain of 1.6 kg. In contrast, metformin and a-glucosidase inhibitors have a modest weight-lowering potential (27,28).

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