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Can J Diabetes. 2018 Feb;42(1):56-60. doi: 10.1016/j.jcjd.2017.03.006. Epub 2017 Jun 7.

Effects on Diabetes Medications, Weight and Glycated Hemoglobin Among Adult Patients With Obesity and Type 2 Diabetes: 6-Month Observations From a Full Meal Replacement, Low-Calorie Diet Weight Management Program.

Author information

1
LEAF Weight Management Clinic, Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: dr.shiau@leafwmc.com.
2
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
3
Weight Management Clinic, Ottawa Hospital, Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

OBJECTIVES:

A 6-month weight-management program with full meal replacement, low-calorie diet (full MR-LCD) (900 kcal/day for 6 to 12 weeks) follows a protocol for patients with diabetes for decreasing or discontinuing weight-gaining diabetes medications first (Group WG) and then titrating weight-neutral medications (Group WN).

METHODS:

This is a retrospective cohort study (1992 to 2009) of weight, glycemic control and diabetes medications changes in 317 patients with obesity and type 2 diabetes who were taking medications.

RESULTS:

Group WG and Group WN were similar at baseline, except that glycated hemoglobin (A1C) levels were significantly lower in Group WN (7.5% vs. 6.6%; p<0.001). At 6 months, both groups had lost 16% of their weight, and the decreases or discontinuations of medications were 92.1% sulfonureas, 86.5% insulins, 78.8% thiazolidinediones, 77.8% alpha-glucosidase inhibitors, 50% meglitinides, 33.3% dipeptidyl peptidase-4 (DPP-4) inhibitors and 32.8% metformin. At 6 months, compared with baseline, A1C levels improved in Group WG and Group WN (6-month A1C levels 6.7% and 5.8%, respectively; p<0.0001), and Group WN had significantly better A1C levels than Group WG. At 6 months, 30% of patients were no longer taking diabetes medications and had significantly better percentages of weight loss compared with those taking medications (18.6% vs. 16%; p=0.002); both groups had improved glycemic control at 6 months (A1C 6.0% vs. A1C 6.6%; NS).

CONCLUSIONS:

In patients with obesity and type 2 diabetes taking medications, a full MR-LCD program appears to be safe and includes improvement in A1C levels. At 6 months, the percentage of weight loss can be significantly better in patients who no longer require diabetes medications, and A1C levels are best controlled in patients who are on WN medications.

KEYWORDS:

changements de médicaments; diabetes; diabète; low-calorie diet; meal replacement; medication changes; perte de poids; régime hypocalorique; substitut de repas; weight loss

PMID:
28600119
DOI:
10.1016/j.jcjd.2017.03.006
[Indexed for MEDLINE]

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