Weight gain and insulin therapy

Abstract

Weight gain is common with insulin therapy in type 1 and type 2 diabetes. Excessive weight gain worsens glycaemic control and increases cardiovascular risk. It can also increase diabetic morbidity and mortality if it acts as a psychological barrier to initiation or intensification of insulin therapy, or affects compliance. Insulin-associated weight gain might result from conservation of previously excreted glucose, defensive `snacking' caused by fear or experience of hypoglycaemia, or the `unphysiological' pharmacokinetic profiles that follow sc insulin administration. Strategies to limit insulin-mediated weight gain include increasing insulin sensitivity through dietary modification, exercise or insulin sensitising drugs. Attempts to replace insulin using regimens that accurately mimic physiological norms should also enable insulin to be dosed with maximum efficiency. The novel analogue insulin, detemir, has not of the pharmacological mechanisms underlying this shown the usual propensity for weight gain. Elucidation of the pharmacological mechanisms property could further clarify mechanism linking insulin with weight regulation.

Combination of the dipeptidyl peptidase-4 inhibitor linagliptin with insulin-based regimens in type 2 diabetes and chronic kidney disease

“…This finding is important considering that treatment with insulin has been associated with significant weight gain. 29 An important limitation of this study is that, although all efficacy and safety endpoints reported are in accordance with the respective protocol definitions of the two trials, analyses specifically addressing T2DM patients with CKD on insulin background therapy were retrospective in nature. It should also be noted that Study 1 and Study 2 were analysed separately.…”

Evaluation of the weight‐increasing effects of biphasic analog and regular NPH insulin mixtures in patients with Type 2 diabetes mellitus

“…Thus, there is greater insulin in the periphery and less in the liver than normal. This situation may explain the increase in fat mass seen with insulin treatment 3 6 …”

“…In 2000, there were 171 million individuals with diabetes worldwide; it has been predicted that, by 2030, this will increase to 366 million 2 . More than 80% of patients with Type 2 DM (T2DM) are already overweight 3 . In addition, insulin and treatment with certain oral antidiabetic agents can cause weight gain, which makes reaching target glycemic levels difficult and increased diabetes‐associated morbidity and mortality 4,5 .…”

“…Mild hypoglycemia stimulates the appetite and people with frequent mild hypoglycemic episodes increase their food intakes 4 . Unbalanced pharmacokinetic and metabolic profiles that cannot fully capture normal physiology have also been shown to produce weight gain 3 . Endogenous insulin is released into the portal circulation; however, subcutaneously injected insulin is released into the systemic circulation and later ends up in the liver.…”

“…2 More than 80% of patients with Type 2 DM (T2DM) are already overweight. 3 In addition, insulin and treatment with certain oral antidiabetic agents can cause weight gain, which makes reaching target glycemic levels difficult and increased diabetes-associated morbidity and mortality. 4,5 The primary aim in controlling diabetes is to avoid early and late-stage complications of the disease by leading a physically and psychosocially healthy lifestyle.…”