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Weight gain in type 2 diabetes mellitus
Author(s) -
Jacob A. N.,
Salinas K.,
AdamsHuet B.,
Raskin P.
Publication year - 2007
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2006.00622.x
Subject(s) - pioglitazone , medicine , metformin , weight gain , type 2 diabetes , endocrinology , insulin , adiponectin , diabetes mellitus , glycosuria , repeated measures design , type 2 diabetes mellitus , analysis of variance , leptin , insulin resistance , obesity , body weight , statistics , mathematics
Objective: To investigate the potential causes of weight gain using insulin and combination therapy in type 2 diabetes. Design and methods: This was an open‐label prospective study of 6‐month duration. Randomization was performed to insulin monotherapy, insulin and pioglitazone 30 mg daily, or insulin and metformin up to 2000 mg daily. Fifty‐seven subjects with poorly controlled type 2 diabetes were enrolled. The goal was to achieve a normal haemoglobin A1c (HbA1c) (<5.6%). Weight, resting energy expenditure (REE), reported energy intake and total energy expenditure, HbA1c, glycosuria, plasma leptin, ghrelin and adiponectin levels, and body fat were measured. Results: A total of 49 subjects completed the study. At baseline, weight was 89.4 ± 22.9 kg and HbA1c was 11.1 ± 1.5%. Weight increased by 7.46, 7.60 and 7.12 kg in the monotherapy, metformin and pioglitazone groups, respectively [p = 0.98 between and <0.0001 within the groups by repeated measures‐analysis of variance (RM‐anova)]. HbA1c dropped to 7.8 ± 0.9% in the monotherapy arm, 7.6 ± 1.0% in the metformin arm and 7.2 ± 1.2% in the pioglitazone arm. Reported energy intake decreased. Glycosuria decreased but was not correlated with weight gain, while HbA1c changes were correlated with weight gain. REE per lean mass decreased (p = 0.04 by RM‐anova). The subcutaneous fat areas in the insulin monotherapy and pioglitazone arms showed increases (p = 0.02 and 0.004 respectively). Conclusions: Weight gain was probably not due to an increase in food intake, while REE per lean body mass decreased, suggesting a role for increased efficiency in fuel usage due to improved glycaemic control. A drop in glycosuria probably also contributed to weight gain. In the monotherapy and pioglitazone arms, the subcutaneous fat areas increased.