orlistat is a lipase inhibitor that alters the absorption of fat through the gastrointestinal (GI) tract
results in the excretion of approximately 30% of ingested fat - thus reducing the calorie intake of the patient
studies have demonstrated that orlistat is clinically beneficial in reducing body weight and co-morbid risk factors in patients with Type 2 diabetes treated concomitantly with oral hypoglycaemic medications (1,2,3)
orlistat and effects on glycaemia
the XENical in the Prevention of Diabetes in Obese Subjects (XENDOS) study revealed that orlistat can also delay or prevent the development of Type 2 diabetes in high-risk patients (4)
use of orlistat in newly diagnosed type 2 diabetics not receiving oral hypoglycaemic agents
a study investigated evaluated the efficacy of 24 weeks’ treatment with orlistat, combined with a mildly reduced-calorie diet, on weight loss and glycaemic control in overweight and obese patients with newly diagnosed and previously untreated Type 2 diabetes (5)
study results revealed that orlistat-treated patients achieved a significantly greater decrease in fasting plasma glucose (-1.3 vs. -0.5 mmol/l; P = 0.0003) and in the 2-h oral glucose tolerance test (-4.1 vs. -1.4 mmol/l; P < 0.0001) than placebo recipients
a significant decrease in HbA1c from baseline was obtained with orlistat (-1.0 vs. -0.6%; P = 0.0008)
various studies have revealed the glycaemic benefits of using orlistat in patients with type 2 diabetes (1,2,3)
use of orlistat in patients already treated with maximal metformin and sulphonylyurea treatment (3) was investigated in a small study
total of 60 female type 2 diabetic patients with BMI > 25 kg/m2 and glycosylated haemoglobin (HbA1c) > 8% were assigned to two groups. In addition to their maximal doses of sulphonylureas (gliclazide (320 mg/day) or glipizide (20 mg/day)) and metformin (2000 mg/day), one group (n = 30) received a placebo and the other (n = 30) received orlistat (120 mg t.i.d.) for 12 weeks
study results revealed that mean fasting insulin levels decreased more in the orlistat group than in the placebo group (28.8 ± 3.0 vs. 2.4 ± 1.2 pmol/l; p < 0.01)
mean HbA1c values dropped by 1.7 ± 0.01% (p < 0.05) in the orlistat group, but remained unchanged in the placebo group
based on the glycaemic lowering effects of orlistat seen in studies, orlistat was classified as an oral hypoglycaemic agent in Canada in 2003 (6)
Reference:
(1) Hollander PA et al. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study. Diabetes Care 1998; 21: 1288-1294.
(2) Hanefeld M et al The effects of orlistat on body weight and glycaemic control in overweight patients with type 2 diabetes: a randomized, placebo-controlled trial. Diabetes Obes Metab 2002; 4: 415- 423.
(4) Torgerson JS et al. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004; 27: 155-161
(6) Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, Can. J. Diabetes 2003;27 (Suppl. 2): S1–S152.
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