QJM Advance Access originally published online on August 31, 2007
QJM 2007 100(10):665; doi:10.1093/qjmed/hcm078
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Weight gain from common drugs
Sir,The authors of the review in your July issue1 are surely misguided in devoting approximately 40% of their Table 2 to drugs used in the treatment of type 2 diabetes, when this condition would have been excluded had they applied the criteria by which they removed type 1 diabetes from consideration. Both conditions are the result of inadequate action of insulin, and in both, certainly if diagnosed clinically rather than by metabolic screening, weight loss is a usual feature, even if many type 2 patients are still overweight after it.2
Type 2 diabetes is treated by increasing either or both of the supply of insulin and the patient's responsiveness to insulin's action. This latter can be achieved by a negative energy balance, which indeed lowers glycaemia even before appreciable weight loss has occurred. Only thus is improved glycaemic control accompanied by sustained weight loss. When insulin's action is increased otherwise, the improved glycaemic control is usually accompanied by weight gain, whether through more positive calorie, water or nitrogen balance.3
The different aetiologies and pathogenicities of the two conditions (and type 2 is a myriad in itself) should not blind one to their essential metabolic similarity. Without sustained stringent dieting, weight gain is a feature of improved glycaemic control in type 2 as well as in type 1 diabetes. The UKPDS, at least for the earlier years after diagnosis of type 2 diabetes, found glycaemic control, and that of blood pressure and lipids, much more important for health than was weight loss.
What the authors are helpfully illuminating is the conundrum as to whether the obesity so frequent in type 2 diabetic patients is merely a precipitating factor, or an integral part of the pathogenesis of its commoner forms. This emphasizes the inadequacy of present hypoglycaemic agents in the management of this obesity, and could be a most useful stimulus to improved treatment. Obesity needs therapy rather than exhortation.
East Hanney
Oxfordshire
UK
email: derekhock{at}btinternet.com
References
1. Leslie WS, Hankey CR, Lean MEJ. Weight gain as an adverse effect of some commonly prescribed drugs: a systematic review. Q J Med (2007) 100:395–404.[Web of Science]
2. Drivsholm T, Olivarus N de F, Nielsen ABS, Siersma V. Symptoms, signs and complications in newly diagnosed type 2 diabetic patients, and their relationship to glycaemia, blood pressure and weight. Diabetologia (2005) 48:210–14.[CrossRef][Web of Science][Medline]
3. Packianathan IC, Fuller NJ, Peterson DB, Wright A, Coward WA, Finer N. Use of a reference four-compartment model to define the effects of insulin treatment on body composition in type 2 diabetes: the ‘Darwin study’. Diabetologia (2005) 48:222–9.[CrossRef][Web of Science][Medline]
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