SAN DIEGO — Real-world weight changes that occur in diabetic patients with initiation of glucose-lowering drugs generally mirror what is seen in carefully controlled clinical trials, Gregory A. Nichols, Ph.D., reported at the annual scientific sessions of the American Diabetes Association.
Chart reviews of 12,521 new diabetes drug initiations among 9,546 diabetic enrollees in Kaiser Permanente Northwest revealed that patients typically gained about 2 pounds within a year of starting a sulfonylurea, 9 pounds after initiation of insulin, and 11 pounds with thiazolidinedione therapy. With metformin, on the other hand, patients lost about 5 pounds. Differences between all the groups were statistically significant.
“We make no value judgments about the drugs or their weight effects. Tight control, however achieved, is undoubtedly more important than any of the weight changes we observed,” said Dr. Nichols, of Kaiser Permanente's Center for Health Research, Portland, Ore.
Age, sex, hemoglobin A1c, history of peripheral artery disease, use of selective serotonin reuptake inhibitors, and whether the agent was the first diabetes drug the patient had been treated with were all significant predictors of weight change. However, adjusting for those and other demographic and clinical characteristics made little difference in the results, he noted.
Although metformin has been increasingly used as first-line glucose-lowering therapy, sulfonylureas were still the most common first-line treatment (54%) among the 1,549 who were subsequently started on a second diabetes drug. Weight changes with the addition of the second agent in this subgroup followed similar patterns. For example, the 833 in whom metformin was added to sulfonylurea first gained 6.4 pounds, then lost 5.6 pounds. At the other extreme, the 26 in whom thiazolidinediones were added to insulin gained 14.7 pounds, then gained 11.2 more.