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Evidence summaries

Pharmacotherapy for Weight Loss in Adults with Type 2 Diabetes Mellitus

Orlistatplus lifestyle intervention is effective for weight loss and more effective than lifestyle interventon alone in adults with type 2 diabetes. Level of evidence: "A"

A meta-analysis assessing 2 the effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus included 12 RCTs. The overall mean weight reduction (3, 6 and 12 months) in the orlistat group was -4.25 kg (95% CI -4.5 to -3.9 kg). The mean weight difference between treatment and control groups was -2.10 kg (95% CI -2.3 to -1.8 kg, P < 0.001), the mean HbA1c difference was -6.12 mmol /mol (95% CI -10.3 to -1.9, P < 0.004) and the mean fasting blood glucose difference was -1.16 mmol /L( 95% CI - 1.4 to -0.8 mmol /L, P < 0.001). Treatment with orlistat plus lifestyle intervention resulted in significantly greater weight loss and improved glycaemic control in overweight and obese patients with type 2 diabetes compared with lifestyle intervention alone.

A Cochrane review [Abstract] 1 included 22 studies, with a total of 296 participants for fluoxetine, 2036 for orlistat, and 1047 for sibutramine. Pharmacotherapy produced modest reductions in weight for fluoxetine (5.1 kg (95% confidence interval [CI], 3.3-6.9) at 24 to 26 weeks follow up; orlistat 2.0 kg (CI, 1.3-2.8) at 12 to 57 weeks follow-up, and sibutramine 5.1 kg (CI, 3.2-7.0) at 12 to 52 weeks follow-up. Glycated hemoglobin also modestly and significantly reduced for fluoxetine and orlistat. Gastrointestinal side effects were common with orlistat; tremor, somnolence and sweating with fluoxetine; and palpitations with sibutramine.

    References

    • Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005 Jan 25;(1):CD004096. [PubMed]
    • Aldekhail NM, Logue J, McLoone P et al. Effect of orlistat on glycaemic control in overweight and obese patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2015;16(12):1071-80. [PubMed]

Primary/Secondary Keywords