Intervention Review

Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus

  1. Susan L Norris1,*,
  2. Xuanping Zhang2,
  3. Alison Avenell3,
  4. Edward Gregg2,
  5. Christopher H Schmid4,
  6. Joseph Lau5

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 29 JUN 2004

DOI: 10.1002/14651858.CD004096.pub2

Database Title

Additional Information

How to Cite

Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004096. DOI: 10.1002/14651858.CD004096.pub2.

Author Information

  1. 1

    Oregon Health Sciences University, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon, USA

  2. 2

    Center for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, USA

  3. 3

    University of Aberdeen, Health Services Research Unit, Aberdeen, UK

  4. 4

    Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, USA

  5. 5

    Tufts Medical Centre, New England Medical Centre/Tufts Evidence-based Practice Center Institute for Clinical Research and Health Policy Studies, Boston, MA, USA

*Susan L Norris, Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Mail Stop B1CC, Portland, Oregon, 97239, USA. norriss@ohsu.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Obesity is closely related to type 2 diabetes and long-term weight reduction is an important part of the care delivered to obese persons with diabetes.

Objectives

To assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.

Search methods

Computerized searches were performed of MEDLINE, EMBASE, Web of Science and other electronic bibliographic databases, supplemented with hand searches of reference lists and selected journals.

Selection criteria

Randomized, controlled trials were included where pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished literature in any language and with any study design was included.

Data collection and analysis

Two reviewers abstracted data and the quality of included studies was evaluated by assessing potential attrition, as well as selection and measurement bias, and a Jadad score was obtained. Effects were combined using a random effects model.

Main results

A sufficient number of studies were available for a quantitative synthesis for fluoxetine, orlistat, and sibutramine. Twenty two randomized controlled trials were included in the review, with a total of 296 participants for fluoxitine, 2036 for orlistat, and 1047 for sibutramine. Pharmacotherapy produced modest reductions in weight for fluoxetine (5.1 kg (95% confidence interval [CI], 3.3 - 6.9) at 24 to 26 weeks follow up; orlistat 2.0 kg (CI, 1.3 - 2.8) at 12 to 57 weeks follow-up, and sibutramine 5.1 kg (CI, 3.2 - 7.0) at 12 to 52 weeks follow-up. Glycated hemoglobin also modestly and significantly reduced for fluoxetine and orlistat. Gastrointestinal side effects were common with orlistat; tremor, somnolence and sweating with fluoxetine; and palpitations with sibutramine. Some studies, using a variety of study designs, were available on other drugs and a significant decrease in weight was noted in three studies of mazindol, one of phenmetrazine, two of phentermine. No studies were identified that fit inclusion criteria for pseudoephedrine, ephedra, sertraline, yohimbine, amphetamine or its derivatives, bupropion, topiramate, benzocaine, threachlorocitric acid, sertraline, and bromocriptine.

Authors' conclusions

Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 12 to 57 weeks. The magnitude of weight loss is modest, however, and the long-term health benefits remain unclear. The safety of sibutramine is uncertain. There is a paucity of data on other drugs for weight loss or control in persons with type 2 diabetes.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus

Obesity is closely related to type 2 diabetes and weight reduction is an important part of the care delivered to obese persons with diabetes. This review of drugs for weight loss among adults with type 2 diabetes revealed weight loss of between 2.0 and 5.1 kg for fluoxetine, orlistat and sibutramine at follow-up of up to 57 weeks. The long-term effects remain uncertain. Adverse events were common in all three drugs: gastrointestinal side effects with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine. There were few studies examining other drugs used for weight loss in populations with diabetes.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

第2型糖尿病成人的減重藥物治療

肥胖和第2型糖尿病是密切相關的，長期減重對肥胖的糖尿病患者來說是很重要的

目標

評估減重藥物在第2型糖尿病患者的治療效果

搜尋策略

針對MEDLINE(1966年1月至2004年5月)、EMBASE(1974年1月至2004年5月)、Web of Science(1981年1月至2004年5月)和其他電子書目資料庫進行搜尋，輔以手工檢索參考資料列表和特定期刊。

選擇標準

本研究包含在第2型糖尿病成人進行以藥物為減重主要策略的隨機和對照試驗。本研究包含任何語言的和任何研究設計的發表或未發表的文獻。

資料收集與分析

兩個審評將資料進行摘要，以潛在的歸因、選擇和測量的誤差評估所納入研究的品質，也有做Jadad score的評估。以隨機效應模型來合併影響效果

主要結論

有足夠數量的研究可用於定量合成fluoxetine，orlistat和sibutramine。22個隨機對照試驗被納入此回顧性研究，其中包含了296個參加fluoxetine研究的人、2036參與orlistat研究的人、1047個參與sibutramine研究的人。在fluoxetine治療24至26週後產生中等程度的體重下降(5.1公斤(95％信賴區間(CI)為3.3 −6.9);以orlistat治療12至57週後體重下降2.0公斤(CI為1.3 −2.8)；以sibutramine治療12至52週後體重下降5.1公斤(CI為3.2 −7.0)。以fluoxetine和orlistat治療後糖化血色素也產生了中等程度且有統計顯著意義的下降。以orlistat治療常見有胃腸道副作用；以fluoxetine治療常見有顫抖、嗜睡和出汗的副作用;以sibutramine治療則常見有心悸的副作用。有三個關於mazindol的研究、一個關於phenmetrazine的研究和兩個關於phentermine的研究顯示體重有明顯的下降。關於pseudophedrine、ephedra、sertraline、yohimbine、amphetamine或它的衍生物、bupropion、topiramate、benzocaine、threachlorocitric acid、sertraline和bromocriptine這些藥物，則找不到符合納入標準的研究。 ◆

作者結論

以Fluoxetine、orlistat和sibutramine治療12至57週的時間內可達到有統計顯著意義的體重減輕。減肥的程度是適中的，但長期對健康的好處仍不清楚。Sibutramine的安全性並不確定。其他減肥藥物對第2型糖尿病病人的體重減輕或控制效果則缺乏相關數據。

翻譯人

本摘要由臺灣大學附設醫院尤則雅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

使用fluoxetine、orlistat和sibutramine做為主要減重方式在第2型糖尿病成人可以達到適中的短期減重效果。 肥胖和第2型糖尿病是密切相關的，減重是照顧肥胖的糖尿病病人中很重要的一部分。此次回顧整理減重藥物對第2型糖尿病成人的效果，發現fluoxetine、orlistat和sibutramine在長達57週的追蹤時間可使體重下降2.0到5.1公斤。但長期影響仍然不清楚。副作用在此三藥中常見：以orlistat治療可能出現胃腸道副作用；以fluoxetine治療可能出現顫抖、嗜睡和出汗的副作用;以sibutramine治療則可能出現心悸的副作用。僅有一些少數的研究測試其他藥物在糖尿病族群的減重效果。 ◆

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