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Improvement of glycaemic control with rebound following orlistat initiation and cessation associated with minimal weight change
Author(s) -
González S.,
Kilpatrick E. S.,
Atkin S. L.
Publication year - 2005
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.1464-5491.2005.01431.x
Subject(s) - medicine , orlistat , weight loss , smoking cessation , weight change , obesity , pathology
A 57‐year‐old Caucasian woman with Type 2 diabetes treated for seven years with diet and oral combination hypoglycaemic therapy was referred because of the progressive deterioration of glycaemic control. She was obese (77 kg, BMI = 39.9), hypertensive, hypercholesterolaemic with marked osmotic symptoms (HbA 1c 12.2%), therefore she was started on insulin (Human Mixtard 30 b.d.) with metformin therapy. Dietary counselling, recommendations to increase physical activity, and supervised self‐injection technique with titration of her insulin were also provided. She was routinely followed‐up to assess her progress. Two years later, her glycaemic control remained suboptimal. Average HbA 1c was 10.4% despite an increasingly high dose of insulin (94 units/day) although it improved when metformin was increased to 1 g t.d.s. (HbA 1c = 9.3%). Her BMI progressively rose from 39.9 to 42.1 (77 to 82.5 kg) despite dietary advice. A trial of orlistat (three months) was commenced, after intensive dietary counselling, that reduced her body weight by 1.5 kg (2% reduction, BMI 41.3). However, her HbA 1c improved by 0.5% (from 9.3 to 8.8%). Six months after orlistat was stopped her HbA 1c rose to 10.5% and weight increased to 81.8 kg (BMI 41.8). Despite the orlistat treatment broaching NICE guidelines should it have been continued?