ACTA ENDOCRINOLOGICA (BUC)

Background. Up to this point, individual or population-based approaches for treating and preventing obesity have not yielded lasting success. We assessed the impact of orlistat with or without metformin on anthropometric and laboratory measurements as well as cardiovascular risk factors in patients suffering from severe obesity. Methods. A total of 116 patients with morbid obesity, consisting of 105 females and 11 males, were involved in the study. Of these, 30 patients (29 females and 1 male) underwent treatment with orlistat, while 86 patients (70 females and 10 males) were given a combination of orlistat and metformin. The effects of orlistat treatment, either 360 mg/day alone or orlistat plus metformin at a dose of 1700 mg/day, were retrospectively examined in patients who had been compliant with therapy for at least three months and had also made adjustments to their diet and lifestyle. Results. The mean age in the orlistat group was 46.26 ± 11.30 years, and 43.13 ± 11.37 years in the orlistat plus metformin group. Significant reductions in weight, body mass index (BMI), waist circumference (WC), systolic blood pressure (BP), total cholesterol, LDL-cholesterol, and carotid intima media thickness (CIMT) resulted from three months of orlistat treatment (p < 0.01). The combination of orlistat and metformin produced substantial reductions in weight, BMI, WC, systolic BP, diastolic BP, CIMT, fasting blood glucose, total cholesterol levels, homeostatic model assessment for insulin resistance (HOMA-IR), and HbA1c levels (p < 0.01). The groups showed comparable weight, BMI, and WC. Neither group experienced notable side effects. Conclusions. Treatments with orlistat and orlistat in combination with metformin led to a significant reduction in body weight. Similar body weight changes were observed between the groups, whereas the alterations in fasting plasma glucose, HOMA-IR, and HbA1c levels were greater with orlistat combined with metformin treatment.

Objective. The aim of this study was to compare the clinical effects of a triple oral antidiabetic combination versus basal insulin and metformin combination treatment in patients with poorly controlled type 2 diabetes.\r\nMethods. Eighty patients with type 2 diabetes, who were treated by metformin and sulphonylurea combination, and had\r\nHbA1c values between 7.5 and 10 % (58 and 86 mmol/L), were randomized into two groups. The first group was given triple oral antidiabetic therapy (pioglitazone, metformin, and sulphonylurea) and the second group was given metformin and a bedtime basal insulin (insulin detemir) combination for 12 weeks. Metabolic parameters were evaluated.\r\nResults. The mean fasting plasma glucose and HbA1c levels decreased in both groups. The decrease in HbA1c was slightly\r\nhigher in triple oral antidiabetic group (p=0.046). The patients in triple oral combination group gained 0.2 kg (p=0.881) and those in the metformin-insulin detemir combination group lost 1.7 kg (p=0.001) in 12 weeks (p=0.29 between groups). The frequency of hypoglycemia was higher in\r\ntriple oral antidiabetic group (11 vs. 2 episodes, respectively).\r\nConclusion. Both sulphonyureametformin-pioglitazone and insulin detemir-metformin therapies provided significant improvements in glycemic control. However, sulphonylurea,\r\npioglitazone and metformin combination led to more frequent hypoglycemic events, and weight management seemed in favor of insulin detemir-metformin combination.