Glitazone therapy linked to rapid weight gain

By Richard Woodman

LONDON (Reuters Health) – Patients with type 2 diabetes put on weight rapidly when prescribed the new glitazone drugs, participants of an obesity conference were told on Tuesday.

Dr. David Matthews, of the Diabetes Research Laboratory at the Radcliffe Infirmary in Oxford, said therapies that increase insulin secretion are generally associated with progressive weight gain of around 4 kilos.

However, weight gain was much more likely with some therapies than with others, he told a conference in London organised by the Association for the Study of Obesity.

Patients treated less intensively for their glycaemia and those given metformin put on less weight than those on insulin or sulphonylurea. The fastest weight gain, 3 kilos in about 6 months, was seen in patients on glitazone (thiazolidinedione) therapy.

Dr. Matthews stressed that of the two evils, hypoglycaemia was worse than weight increase. But he added: "With the advent of thiazolidinediones, where weight increases even faster than with insulin or sulphonylurea, we will need to wait for the outcome of clinical trials before deciding whether these agents are suitable for widespread use or whether we should reserve them for specific indications."

He told Reuters Health that European drug regulators had been much more cautious than their American colleagues, recommending that the new drugs be used in combination with metformin rather than alone. "But as to who is right, there is no easy answer."

He stressed that dietary intervention on its own was very effective in the early stages of type 2 diabetes. "People fail to realise that it is very important not to just put people on to therapeutic agents from day one."

Looking to the future, he said new classes of drugs, such as GLP1 analogues, might have the potential to control glycaemia without weight increase. "Certainly, this seems to be a finding in primate studies."

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