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Energy Expenditure in Type 2 Diabetic Patients on Metformin and Sulphonylurea Therapy
Author(s) -
Chong P. K. K.,
Jung R. T.,
Rennie M. J.,
Scrimgeour C. M.
Publication year - 1995
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1995.tb00503.x
Subject(s) - metformin , medicine , endocrinology , resting energy expenditure , type 2 diabetes , body mass index , diabetes mellitus , combination therapy , basal metabolic rate , doubly labeled water , energy expenditure
Insulin and sulphonylurea therapies have both been reported to cause weight gain in Type 2 diabetic patients whereas metformin does not have this adverse effect. The mechanism for this difference is unclear. We have investigated in a cross‐over study the effect of sulphonylurea and metformin therapy on energy expenditure and body composition in 10 Type 2 diabetic patients (7 females, 3 males) of various weights (mean body mass index 33.4 (SD 7.6 kg m −2 )). Free living total energy expenditure was measured over 14 days by the doubly labelled water method adjusted for urinary glucose energy losses and resting energy expenditure by ventilated hood indirect calorimetry. Overall, total energy expenditure (12.88 ± 4.17 vs 13.1 ± 3.69 MJ 24 h −1 ) and resting metabolic rate (7.30 ± 1.75 vs 7.23 ± 1.74 MJ 24 h −1 ) were similar on metformin and sulphonylurea therapy, respectively. When adjusted for differences in fat free mass, resting metabolic rate on sulphonylurea therapy was slightly but significantly lower (mean difference −5.5 kJ 24 h −1 kg −1 , 95% CI −1.2, −9.9 kJ 24 h −1 kg −1 , p < 0.05). Fat free mass also increased significantly by 1.3 kg (95% CI 0.4, 2.4 kg, p < 0.05) when on sulphonylurea therapy, thus compensating for the lower resting metabolic rate per kg fat free mass to leave overall resting metabolic rate unchanged compared to metformin therapy. We also investigated the effect of adding metformin to six Type 2 diabetic patients already on insulin. This did not lead to any measurable changes in any of the components of energy expenditure. Our results suggested that the weight gain of 0.8 kg with sulphonylurea was secondary to a relatively greater energy intake and/or metabolizable energy availability, possibly augmented by a slightly lower resting metabolic rate when adjusted for differences in fat free mass.