Endocrine Abstracts

This study was designed to evaluate whether weight change in type 2 diabetes leads to deteriorating glycaemic control necessitating treatment escalation, or whether deteriorating glycaemic control results in medication change and possible weight gain.
We studied 702 type 2 diabetic subjects with a follow-up of 56 plus/minus 2 months (mean plus/minus S.E.) treated on diet, metformin or sulphonylurea, alone or in combination. Patients who remained on diet alone (40 plus/minus 1 month) showed a significantly lower HbA1c, 5.4 plus/minus 0.1 percent (p less than 0.0001), than patients who changed to sulphonylurea 6.5 plus/minus 0.1 percent, or metformin, 6.6 plus/minus 0.1 percent,when evaluated at a similar time-point ( 17 plus/minus 2 months post diagnosis). However weight change from diagnosis was similar in the 3 groups ( minus 1.6 plus/minus 0.4 Kilogram; minus 1.3 plus/minus 0.5 Kilogram; and minus 1.4 plus/minus 0.4 Kilogram respectively), ( p greater than 0.05).
Patients who remained on treatment with metformin, or sulphonylurea alone similarly demonstrated significantly lower HbA1c values, 6.6 plus/minus 0.1 percent and 6.7 plus/minus 0.1 percent respectively, than patients who required addition of the second oral agent, 7.0 plus/minus 0.2 percent ( p less than 0.05); weight changes in patients remaining on monotherapy and those requiring treatment escalation were not significantly different.
Metformin use was associated with weight loss, minus 1.24 plus/minus 0.3 Kilogram, over 29 plus/minus 1 months (n = 327), while sulphonylurea treatment was associated with weight gain plus 1.47 plus/minus 0.3 Kilogram over 30 plus/minus 1 month ( n= 265) (p less than 0.0001); however HbA1c levels were similar in these patients,7.0 plus/minus 0.1 percent and 6.9 plus/minus 0.1 percent.
These data indicate that patients who require oral treatment escalation for elevated HbA1c values despite diet, metformin or sulphonylurea alone do not gain more weight than patients maintained on these treatments alone. Addition of metformin results in weight loss and addition of sulphonylurea results in weight gain with similar effects on HbA1c levels.