Insulin Treatment and the Problem of Weight Gain in Type 2 Diabetes

Carver, Catherine

doi:10.1177/0145721706294259

Cited by 96 publications

(82 citation statements)

References 80 publications

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“…Current treatment options for glycemic control are significantly limited for patients with type 2 diabetes and CKD (5,(8)(9)(10)(11), which often leads to the introduction of sulfonylurea and insulin therapy to maintain glycemic control. Further, therapeutic options for glycemic control can be associated with significant risks of hypoglycemia, weight gain, and fluid retention, which may add to the complexity of maintaining blood glucose, body weight, and blood pressure in this population (12)(13)(14)(15).…”

mentioning

confidence: 99%

Efficacy and Safety of the Once-Weekly GLP-1 Receptor Agonist Albiglutide Versus Sitagliptin in Patients With Type 2 Diabetes and Renal Impairment: A Randomized Phase III Study

et al. 2014

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OBJECTIVETo evaluate weekly subcutaneous albiglutide versus daily sitagliptin in renally impaired patients with type 2 diabetes and inadequately controlled glycemia on a regimen of diet and exercise and/or oral antihyperglycemic medications. RESEARCH DESIGN AND METHODSIn this phase III, randomized, double-blind, multicenter, 52-week study, the primary study end point was HbA 1c change from baseline at week 26 in patients with renal impairment, as assessed with estimated glomerular filtration rate and categorized as mild, moderate, or severe ( ‡60 to £89, ‡30 to £59, and ‡15 to £29 mL/min/1.73 m 2 , respectively). Secondary end points included fasting plasma glucose (FPG), weight, achievement of treatment targets, hyperglycemic rescue, and safety. RESULTSBaseline demographics were similar across treatment and renal impairment groups with overall mean age of 63.3 years, BMI of 30.4 kg/m 2 , HbA 1c of 8.2% (66 mmol/mol), and diabetes disease duration of 11.2 years. HbA 1c change from baseline at week 26 was significantly greater for albiglutide than sitagliptin (20.83% vs. 20.52%, P = 0.0003). Decreases in HbA 1c , FPG, and weight were seen through week 52. Time to hyperglycemic rescue through week 52 was significantly longer for albiglutide than sitagliptin (P = 0.0017). Results of safety assessments were similar between groups, and most adverse events (AEs) were mild or moderate. The incidences of gastrointestinal AEs for albiglutide and sitagliptin were as follows: overall, 31.7%, 25.2%; diarrhea, 10.0%, 6.5%; nausea, 4.8%, 3.3%; and vomiting, 1.6%, 1.2%, respectively. CONCLUSIONSOnce-weekly albiglutide therapy in renally impaired patients with type 2 diabetes provided statistically superior glycemic improvement with almost similar tolerability compared with daily sitagliptin therapy.

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mentioning

confidence: 99%

Efficacy and Safety of the Once-Weekly GLP-1 Receptor Agonist Albiglutide Versus Sitagliptin in Patients With Type 2 Diabetes and Renal Impairment: A Randomized Phase III Study

et al. 2014

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“…58 Weight gain occurs early -in the first weeks to months after insulin initiation 59 -then levels off, correlating with the intensity of insulin titration. In one study in which insulin was rapidly titrated over the first 12 weeks, almost 80% of weight gain occurred during this period.…”

Section: Weight Gainmentioning

confidence: 99%

Initiating insulin in patients with type 2 diabetes

Lau¹,

Tang²,

Halapy³

et al. 2012

CMAJ

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T ype 2 diabetes has become a worldwide epidemic 1 and is associated with multiple complications that can be prevented by modifying risk factors and optimizing glycemic control. 2 The optimization of glycemic control often requires the use of multiple agents, including insulin.Insulin is an important component of antihyperglycemic therapy, yet there are many perceived barriers.3 Existing guidelines do not specifically address the topic of insulin initiation. 4 We review and analyze the evidence from randomized controlled trials on insulin initiation and address adverse effects and barriers. We also discuss the selection of an insulin regimen, titration and delivery of care, as well as when and how to combine insulin therapy with oral antihyperglycemic agents. A summary of our systematic review and meta-analysis is available in Box 1. When should insulin be started?Clinical practice guidelines vary as to the recommended criteria for the initiation of insulin therapy in pa tients with type 2 diabetes. Factors that are considered include the control of blood glucose levels and comorbidities that affect choice of treatment. Glucose controlThe American Diabetes Association and the European Association for the Study of Diabetes developed a consensus algorithm wherein basal insulin is recommended as a second-line agent if the glycated hemoglobin (HbA 1 c ) value is greater than 7.0% after metformin monotherapy.5 Similarly, the International Diabetes Federation recommends that insulin be started if optimized oral antihyperglycemic therapy and lifestyle interventions are unable to maintain blood glucose at target levels. 6 In contrast, the Canadian Diabetes Association recommends that insulin be considered as a first-line agent if the HbA 1c value is 9.0% or greater in pa tients with newly diagnosed diabetes or if there is symptomatic hyperglycemia with metabolic decompensation (defined as polyuria, polydipsia and weight loss), and as a second-line agent if the HbA 1c is still not at target levels (consensus recommendation). 4Although no randomized controlled trials have looked at the impact on cardiovascular outcomes of insulin initiation early in the course of type 2 diabetes, early intensive control of blood glucose levels was assessed in the United Kingdom Prospective Diabetes Study (UKPDS). The study compared intensive glycemic control (with metformin, secretagogue or insulin therapy) and conventional glycemic control in patients with newly diagnosed diabetes and found that those in the intensive treatment group had reduced microvascular and macrovascular complications in long-term follow-up. 7,8 Early insulin initiation has been shown to improve and preserve β-cell function, 9 and the ongoing Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial will assess the impact of an early basal insulin strategy on cardiovascular outcomes. 10 ComorbiditiesCareful monitoring of glycemic control is necessary when treating diabetes in patients with renal or hepatic failure. Many oral antihyperglycemic agents are c...

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“…Weight and height were obtained at enrollment, 3,6,12,18, and 24 months. The majority of the weights were obtained on a Detecto balance scale (Detecto, Webb City, MO).…”

Section: Primary Outcomementioning

confidence: 99%

“…Weight gain associated with insulin intensification of glycemic control was noted in the Diabetes Control and Complications Trial, the United Kingdom Prospective Diabetes Study, and other studies of either initiation and/or intensification of insulin therapy (1)(2)(3)(4). One commentary from the United Kingdom Prospective Diabetes Study trial suggested that insulin should not be used as the initial medication in type 2 diabetes due to excessive weight gain (5).…”

mentioning

confidence: 99%

Insulin Use and Weight Maintenance in Well‐controlled Type 2 Diabetes: A Prospective Cohort Study

Huizinga

Niswender

Gebretsadik

et al. 2008

Obesity

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Intensification of glycemic control is associated with weight gain, however, less is known about weight change during the maintenance phase of glycemic management. On the basis of current models of energy homeostasis, we hypothesize that insulin use will result in less weight gain than oral antidiabetic agents in patients with well-controlled diabetes. This is a prospective cohort nested within a randomized control trial at an academic clinic, with enrollment from June 2002 to January 2005. A total of 163 patients with type 2 diabetes were enrolled after obtaining glycemic control. Insulin use was assessed by self-report at baseline. Participants were weighed at baseline and five follow-up visits over 24 months. The weight change was compared between insulin users and noninsulin users. The average (s.d.) age was 55 (11), 44% are female and 21% are black. The median duration of diabetes was 5 (0.5-10) years. At baseline, 88 participants (54%) reported insulin use with an average of 69 (6) units/day. Baseline BMI in the insulin users was 35 (6) and 33 (6) in noninsulin patients. Over 24 months, noninsulin patients gained 2.3 additional kilograms compared with insulin users (2.8 kg (6.8) vs. 0.5 kg (6.5), P = 0.065). After adjusting for age, race, sex, baseline weight, intervention status, and change in A1C, insulin users had 2.5 kg less weight gain than noninsulin users (P = 0.033). Less weight gain was observed over 24 months in insulin-treated patients. Whether this effect may be due to central catabolic effects of insulin merits additional confirmatory study and mechanistic investigation.

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Insulin Treatment and the Problem of Weight Gain in Type 2 Diabetes

Cited by 96 publications

References 80 publications

Efficacy and Safety of the Once-Weekly GLP-1 Receptor Agonist Albiglutide Versus Sitagliptin in Patients With Type 2 Diabetes and Renal Impairment: A Randomized Phase III Study

Efficacy and Safety of the Once-Weekly GLP-1 Receptor Agonist Albiglutide Versus Sitagliptin in Patients With Type 2 Diabetes and Renal Impairment: A Randomized Phase III Study

Initiating insulin in patients with type 2 diabetes

Insulin Use and Weight Maintenance in Well‐controlled Type 2 Diabetes: A Prospective Cohort Study

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