Efficacy of pharmacotherapy for weight loss for adults with type 2 diabetes mellitus: a meta-analysis

S. L. Norris, E. Gregg, Alison Avenell, X. Zhang, J. Lau, Christoph Schmidt

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

Background: Obesity is closely related to type 2 diabetes mellitus, and weight reduction is an important part of the care delivered to obese persons with diabetes. The objective of this review was to assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.

Methods: A systematic review of the literature was performed, and studies were included if pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished studies with any design were included. A random effects model was used to combine outcomes from randomized controlled trials.

Results: Sufficient data for the meta-analysis were available for fluoxetine, orlistat, and sibutramine. Fourteen randomized, placebo-controlled trials were included in the review, with a total of 2231 patients. Pharmacotherapy produced modest reductions in weight for fluoxetine (3.4 kg [95% confidence interval (CI), 1.7-5.2 kg] at 8-16 weeks of follow-up; 5.1 kg [95% CI, 3.3-6.9 kg] at 24-30 weeks; and 5.8 kg [95% CI, 0.8-10.8 kg] at 52 weeks); orlistat (2.6 kg [95% CI, 2.1-3.2 kg] [2.6% loss] at 52 weeks); and sibutramine (4.5 kg [95% CI, 1.8-7.2 kg] [3.3% loss] at up to 26 weeks). Glycated hemoglobin was also modestly reduced: fluoxetine (1.0% [95% CI, 0.4%-1.5%] at 8-16 weeks; 1.0% [95% 0.6%-1.4%] at 24-30 weeks; and 1.8% [95% CI, -0.2%-3.8%] at 52 weeks); orlistat (0.4% [95% CI, 0.3%-0.5%]); and sibutramine (0.7% [95% CI, -0.5%-1.9%]). Gastrointestinal adverse effects were common with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine.

Conclusions: Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 26 to 52 weeks. However, the magnitude of weight loss was modest, and the long-term health benefits and safety remain unclear. Interventions that combine pharmacologic therapy with intensive behavioral interventions may be more effective but need additional research.

Original languageEnglish
Pages (from-to)1395-1404
Number of pages9
JournalArchives of Internal Medicine
Volume164
Issue number13
DOIs
Publication statusPublished - 2004

Keywords

  • LOW-CALORIE DIET
  • OBESE-PATIENTS
  • GLYCEMIC CONTROL
  • LIFE-STYLE
  • CARDIOVASCULAR-DISEASE
  • BEHAVIORAL TREATMENT
  • RANDOMIZED TRIAL
  • HEART-DISEASE
  • DOUBLE-BLIND
  • FLUOXETINE

Cite this

Efficacy of pharmacotherapy for weight loss for adults with type 2 diabetes mellitus: a meta-analysis. / Norris, S. L.; Gregg, E.; Avenell, Alison; Zhang, X.; Lau, J.; Schmidt, Christoph.

In: Archives of Internal Medicine, Vol. 164, No. 13, 2004, p. 1395-1404.

Research output: Contribution to journalArticle

Norris, S. L. ; Gregg, E. ; Avenell, Alison ; Zhang, X. ; Lau, J. ; Schmidt, Christoph. / Efficacy of pharmacotherapy for weight loss for adults with type 2 diabetes mellitus: a meta-analysis. In: Archives of Internal Medicine. 2004 ; Vol. 164, No. 13. pp. 1395-1404.
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abstract = "Background: Obesity is closely related to type 2 diabetes mellitus, and weight reduction is an important part of the care delivered to obese persons with diabetes. The objective of this review was to assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.Methods: A systematic review of the literature was performed, and studies were included if pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished studies with any design were included. A random effects model was used to combine outcomes from randomized controlled trials.Results: Sufficient data for the meta-analysis were available for fluoxetine, orlistat, and sibutramine. Fourteen randomized, placebo-controlled trials were included in the review, with a total of 2231 patients. Pharmacotherapy produced modest reductions in weight for fluoxetine (3.4 kg [95{\%} confidence interval (CI), 1.7-5.2 kg] at 8-16 weeks of follow-up; 5.1 kg [95{\%} CI, 3.3-6.9 kg] at 24-30 weeks; and 5.8 kg [95{\%} CI, 0.8-10.8 kg] at 52 weeks); orlistat (2.6 kg [95{\%} CI, 2.1-3.2 kg] [2.6{\%} loss] at 52 weeks); and sibutramine (4.5 kg [95{\%} CI, 1.8-7.2 kg] [3.3{\%} loss] at up to 26 weeks). Glycated hemoglobin was also modestly reduced: fluoxetine (1.0{\%} [95{\%} CI, 0.4{\%}-1.5{\%}] at 8-16 weeks; 1.0{\%} [95{\%} 0.6{\%}-1.4{\%}] at 24-30 weeks; and 1.8{\%} [95{\%} CI, -0.2{\%}-3.8{\%}] at 52 weeks); orlistat (0.4{\%} [95{\%} CI, 0.3{\%}-0.5{\%}]); and sibutramine (0.7{\%} [95{\%} CI, -0.5{\%}-1.9{\%}]). Gastrointestinal adverse effects were common with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine.Conclusions: Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 26 to 52 weeks. However, the magnitude of weight loss was modest, and the long-term health benefits and safety remain unclear. Interventions that combine pharmacologic therapy with intensive behavioral interventions may be more effective but need additional research.",
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T1 - Efficacy of pharmacotherapy for weight loss for adults with type 2 diabetes mellitus: a meta-analysis

AU - Norris, S. L.

AU - Gregg, E.

AU - Avenell, Alison

AU - Zhang, X.

AU - Lau, J.

AU - Schmidt, Christoph

PY - 2004

Y1 - 2004

N2 - Background: Obesity is closely related to type 2 diabetes mellitus, and weight reduction is an important part of the care delivered to obese persons with diabetes. The objective of this review was to assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.Methods: A systematic review of the literature was performed, and studies were included if pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished studies with any design were included. A random effects model was used to combine outcomes from randomized controlled trials.Results: Sufficient data for the meta-analysis were available for fluoxetine, orlistat, and sibutramine. Fourteen randomized, placebo-controlled trials were included in the review, with a total of 2231 patients. Pharmacotherapy produced modest reductions in weight for fluoxetine (3.4 kg [95% confidence interval (CI), 1.7-5.2 kg] at 8-16 weeks of follow-up; 5.1 kg [95% CI, 3.3-6.9 kg] at 24-30 weeks; and 5.8 kg [95% CI, 0.8-10.8 kg] at 52 weeks); orlistat (2.6 kg [95% CI, 2.1-3.2 kg] [2.6% loss] at 52 weeks); and sibutramine (4.5 kg [95% CI, 1.8-7.2 kg] [3.3% loss] at up to 26 weeks). Glycated hemoglobin was also modestly reduced: fluoxetine (1.0% [95% CI, 0.4%-1.5%] at 8-16 weeks; 1.0% [95% 0.6%-1.4%] at 24-30 weeks; and 1.8% [95% CI, -0.2%-3.8%] at 52 weeks); orlistat (0.4% [95% CI, 0.3%-0.5%]); and sibutramine (0.7% [95% CI, -0.5%-1.9%]). Gastrointestinal adverse effects were common with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine.Conclusions: Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 26 to 52 weeks. However, the magnitude of weight loss was modest, and the long-term health benefits and safety remain unclear. Interventions that combine pharmacologic therapy with intensive behavioral interventions may be more effective but need additional research.

AB - Background: Obesity is closely related to type 2 diabetes mellitus, and weight reduction is an important part of the care delivered to obese persons with diabetes. The objective of this review was to assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.Methods: A systematic review of the literature was performed, and studies were included if pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished studies with any design were included. A random effects model was used to combine outcomes from randomized controlled trials.Results: Sufficient data for the meta-analysis were available for fluoxetine, orlistat, and sibutramine. Fourteen randomized, placebo-controlled trials were included in the review, with a total of 2231 patients. Pharmacotherapy produced modest reductions in weight for fluoxetine (3.4 kg [95% confidence interval (CI), 1.7-5.2 kg] at 8-16 weeks of follow-up; 5.1 kg [95% CI, 3.3-6.9 kg] at 24-30 weeks; and 5.8 kg [95% CI, 0.8-10.8 kg] at 52 weeks); orlistat (2.6 kg [95% CI, 2.1-3.2 kg] [2.6% loss] at 52 weeks); and sibutramine (4.5 kg [95% CI, 1.8-7.2 kg] [3.3% loss] at up to 26 weeks). Glycated hemoglobin was also modestly reduced: fluoxetine (1.0% [95% CI, 0.4%-1.5%] at 8-16 weeks; 1.0% [95% 0.6%-1.4%] at 24-30 weeks; and 1.8% [95% CI, -0.2%-3.8%] at 52 weeks); orlistat (0.4% [95% CI, 0.3%-0.5%]); and sibutramine (0.7% [95% CI, -0.5%-1.9%]). Gastrointestinal adverse effects were common with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine.Conclusions: Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 26 to 52 weeks. However, the magnitude of weight loss was modest, and the long-term health benefits and safety remain unclear. Interventions that combine pharmacologic therapy with intensive behavioral interventions may be more effective but need additional research.

KW - LOW-CALORIE DIET

KW - OBESE-PATIENTS

KW - GLYCEMIC CONTROL

KW - LIFE-STYLE

KW - CARDIOVASCULAR-DISEASE

KW - BEHAVIORAL TREATMENT

KW - RANDOMIZED TRIAL

KW - HEART-DISEASE

KW - DOUBLE-BLIND

KW - FLUOXETINE

U2 - 10.1001/archinte.164.13.1395

DO - 10.1001/archinte.164.13.1395

M3 - Article

VL - 164

SP - 1395

EP - 1404

JO - Archives of Internal Medicine

JF - Archives of Internal Medicine

SN - 0003-9926

IS - 13

ER -