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He Y, Shi L. Anthropometric indicators and cardiovascular diseases risk in pre-diabetic and diabetic adults: NHANES 1999-2018 cross-sectional analysis. Exp Gerontol 2024; 194:112516. [PMID: 38977206 DOI: 10.1016/j.exger.2024.112516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Since cardiovascular disease (CVD) stands as the primary cause of death in those with diabetes, and given the substantial influence of obesity as a common risk factor for both diabetes and atherosclerotic conditions, this investigation sought to find the relationship between anthropometric indicators and CVD risk within these populations. METHODS Our study examined 36,329 adults, including those with diagnosed diabetes, pre-diabetes, and without diabetes from National Health and Nutrition Examination Survey (NHANES) data spanning 1999 to 2018. Various anthropometric indicators such as body mass index (BMI), waist circumference, weight-adjusted waist index (WWI), waist-to-height ratio (WHtR), weight, and height were assessed. Baseline characteristics were compared among the three groups after weighting. Participants were then grouped based on anthropometric indicators, and logistic regression models were used to analyze the association between these indicators and CVD risk in the total diabetes group (including diabetic and pre-diabetic individuals). Threshold effect analysis was conducted to explore nonlinear relationships, and mediation analyses assessed whether serum parameters influenced these relationships. RESULTS This cross-sectional study involved 36,329 participants, weighted to a count of approximately 160.9 million, including over 45.9 million pre-diabetic individuals and around 16.6 million diabetic individuals. Baseline analysis showed significant associations between all six anthropometric indicators and CVD risk across patients with different diabetes statuses. Weighted restricted cubic spline (RCS) curve analysis highlighted increased CVD risk among the total diabetes group for each anthropometric indicator compared to the non-diabetic group. Anthropometric indicators were then divided into quartiles, and after adjusting for confounders, Model 3 revealed that the highest BMI group had a heightened risk of CVD compared to the lowest BMI group. Similar trends were observed in the WWI and WHtR subgroups. Threshold effect analysis of anthropometric indicators unveiled nonlinear associations between waist circumference, height, WWI and CVD risk. Mediation analysis suggested that lipid parameters, especially HDL, significantly mediated these relationships. CONCLUSION In individuals with diabetes and pre-diabetes, BMI, weight, and WHtR displayed a consistent, linear increase correlation with CVD risk. Conversely, the link between waist circumference, height, and WWI and CVD risk showcased a more complex, nonlinear pattern. Moreover, HDL level emerged as notable mediator in the association between anthropometric indicators and the risk of CVD.
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Affiliation(s)
- Yi He
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lingfeng Shi
- Department of Endocrinology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
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Abbasi M, Fan Z, Dawson JA, Wang S. Anti-obesity and metabolic benefits of metformin: Comparison of different delivery routes. J Drug Deliv Sci Technol 2024; 91:105110. [PMID: 38188941 PMCID: PMC10768944 DOI: 10.1016/j.jddst.2023.105110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Obesity is a severe public health problem. Healthy lifestyle interventions are commonly recommended for fighting obesity. But they are hard to follow and have low efficacy. Pharmacotherapy and surgery are of high efficacy but are beset with side effects. Browning subcutaneous white adipose tissue (WAT) is a practical and efficient approach for combating obesity. Metformin, a commonly used FDA-approved antidiabetic drug, is potent to induce browning of WAT through phosphorylation and activation of AMP-activated protein kinase. However, oral administration of metformin has low oral bioavailability, fast renal clearance, and low target specificity that limit metformin's application in browning WAT. Local and transdermal delivery of metformin directly to subcutaneous WAT using injection or microneedle (MN) in combination with iontophoresis (INT) may solve these problems. In this paper, we administered metformin to C57BL/6J obese mice using the following three routes: transdermal delivery (MN and INT), local injection into inguinal WAT (IgWAT, a type of subcutaneous WAT in mice), and oral gavage. The anti-obesity and metabolic effects of metformin via these delivery routes were determined and compared. As compared to local IgWAT injection and oral gavage delivery, transdermal delivery of metformin using MN and INT resulted in 9% lower body weight and 7% decrease in body fat% accompanied by improved energy metabolism and decreased inflammation through browning IgWAT in obese C57BL/6J mice. Transdermal delivery of metformin using MN and INT is an effective approach in browning subcutaneous WAT for combating obesity and improving metabolic health.
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Affiliation(s)
- Mehrnaz Abbasi
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas 79409, USA
- College of Human Sciences, Auburn University, Auburn, AL, 36830, USA
| | - Zhaoyang Fan
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas 79409, USA
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona 85281, USA
| | - John A. Dawson
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas 79409, USA
- Department of Economics, Applied Statistics, and International, New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - Shu Wang
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas 79409, USA
- College of Health Solutions, Arizona State University, Phoenix, Arizona, 85004, USA
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Barenbaum SR, Kumar RB, Aronne LJ. Management of Medication-Induced Weight Gain. Gastroenterol Clin North Am 2023; 52:751-760. [PMID: 37919025 DOI: 10.1016/j.gtc.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Several medications can contribute to weight gain. Medication-induced weight gain can have severe health consequences leading to overweight or obesity, or exacerbation of preexisting obesity and the plethora of obesity-related comorbidities. Weight gain due to medications is potentially avoidable by prescribing medications that are either weight neutral or that lead to weight loss, when appropriate. This article reviews the common classes of medications that contribute to weight gain and discusses alternatives to consider.
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Affiliation(s)
- Sarah R Barenbaum
- Division of Endocrinology, Diabetes & Metabolism, NewYork-Presbyterian Hospital/ Weill Cornell Medical College, Comprehensive Weight Control Center, 1305 York Avenue, 4th Floor, New York, NY 10021, USA.
| | - Rekha B Kumar
- Iris Cantor Women's Health Center, Endocrinology & Internal Medicine, 425 East 61st Street, Fl 11, New York, NY 10065, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes & Metabolism, NewYork-Presbyterian Hospital/ Weill Cornell Medical College, Comprehensive Weight Control Center, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
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Abstract
Importance Obesity affects approximately 42% of US adults and is associated with increased rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death. Observations A body mass index (BMI) of 25 or greater is commonly used to define overweight, and a BMI of 30 or greater to define obesity, with lower thresholds for Asian populations (BMI ≥25-27.5), although use of BMI alone is not recommended to determine individual risk. Individuals with obesity have higher rates of incident cardiovascular disease. In men with a BMI of 30 to 39, cardiovascular event rates are 20.21 per 1000 person-years compared with 13.72 per 1000 person-years in men with a normal BMI. In women with a BMI of 30 to 39.9, cardiovascular event rates are 9.97 per 1000 person-years compared with 6.37 per 1000 person-years in women with a normal BMI. Among people with obesity, 5% to 10% weight loss improves systolic blood pressure by about 3 mm Hg for those with hypertension, and may decrease hemoglobin A1c by 0.6% to 1% for those with type 2 diabetes. Evidence-based obesity treatment includes interventions addressing 5 major categories: behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures. Comprehensive obesity care plans combine appropriate interventions for individual patients. Multicomponent behavioral interventions, ideally consisting of at least 14 sessions in 6 months to promote lifestyle changes, including components such as weight self-monitoring, dietary and physical activity counseling, and problem solving, often produce 5% to 10% weight loss, although weight regain occurs in 25% or more of participants at 2-year follow-up. Effective nutritional approaches focus on reducing total caloric intake and dietary strategies based on patient preferences. Physical activity without calorie reduction typically causes less weight loss (2-3 kg) but is important for weight-loss maintenance. Commonly prescribed medications such as antidepressants (eg, mirtazapine, amitriptyline) and antihyperglycemics such as glyburide or insulin cause weight gain, and clinicians should review and consider alternatives. Antiobesity medications are recommended for nonpregnant patients with obesity or overweight and weight-related comorbidities in conjunction with lifestyle modifications. Six medications are currently approved by the US Food and Drug Administration for long-term use: glucagon-like peptide receptor 1 (GLP-1) agonists (semaglutide and liraglutide only), tirzepatide (a glucose-dependent insulinotropic polypeptide/GLP-1 agonist), phentermine-topiramate, naltrexone-bupropion, and orlistat. Of these, tirzepatide has the greatest effect, with mean weight loss of 21% at 72 weeks. Endoscopic procedures (ie, intragastric balloon and endoscopic sleeve gastroplasty) can attain 10% to 13% weight loss at 6 months. Weight loss from metabolic and bariatric surgeries (ie, laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass) ranges from 25% to 30% at 12 months. Maintaining long-term weight loss is difficult, and clinical guidelines support the use of long-term antiobesity medications when weight maintenance is inadequate with lifestyle interventions alone. Conclusion and Relevance Obesity affects approximately 42% of adults in the US. Behavioral interventions can attain approximately 5% to 10% weight loss, GLP-1 agonists and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists can attain approximately 8% to 21% weight loss, and bariatric surgery can attain approximately 25% to 30% weight loss. Comprehensive, evidence-based obesity treatment combines behavioral interventions, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures as appropriate for individual patients.
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Affiliation(s)
- Arielle Elmaleh-Sachs
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Family Health Centers at NYU Langone, New York, New York
| | - Jessica L Schwartz
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Carolyn T Bramante
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis
| | - Jacinda M Nicklas
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Melanie Jay
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- New York Harbor Veteran Affairs, New York, New York
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Gunay YE, Kişioğlu SV, Karakullukçu S, Tufekcı D, Demır AS, Coskun H, Nuhoglu I, Kocak M, Ersöz HÖ. Comparison of orlistat and orlistat plus metformin therapy between diabetic and nondiabetic groups. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230174. [PMID: 37466599 DOI: 10.1590/1806-9282.20230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The objective of this study was to examine the effects of orlistat use on metabolic control and weight loss in diabetic and nondiabetic patients. METHODS A total of 119 patients with body mass index≥40 kg/m2 and receiving orlistat therapy, who applied to the Endocrinology polyclinic between January 2016 and October 2019, were included. The patients' weight changes and biochemical values (i.e., fasting glucose, HbA1c, ALT, creatinine, and lipid parameters) were evaluated at the drug beginning and the last polyclinic control. The patients were divided into groups, whether they had diabetes or used metformin, and compared. RESULTS The mean age of the 119 patients in the study was 45.3±11.5 years. A total of 94.1% of the patients were females and 5.9% were males. A total of 38.7% of the patients had diabetes and 29.4% had prediabetes. When the patients were compared to whether they had diabetes or used metformin, there was a statistically significant difference between the groups according to weight loss. The mean weight change of patients without diabetes and receiving metformin and orlistat was statistically significantly higher than that of patients with diabetes and receiving metformin and orlistat. DISCUSSION It was determined that the weight loss effect of orlistat in obesity was seen in all groups, but this effect decreased in the diabetic group.
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Affiliation(s)
- Yasemin Emur Gunay
- Giresun Training and Research Hospital, Department of Endocrinology and Metabolism - Giresun, Turkey
| | - Savaş Volkan Kişioğlu
- İstinye University, Faculty of Health Sciences, Yıldızlı Medical Park Hospital, Department of Endocrinology and Metabolism - Istanbul, Turkey
| | - Serdar Karakullukçu
- Karadeniz Technical University, Faculty of Medicine, Department of Public Health - Trabzon, Turkey
| | - Damla Tufekcı
- Karadeniz Technical University, Faculty of Medicine, Department of Endocrinology and Metabolism - Trabzon, Turkey
| | - Ahmet Suat Demır
- Karadeniz Technical University, Faculty of Medicine, Department of Endocrinology and Metabolism - Trabzon, Turkey
| | - Hülya Coskun
- Karadeniz Technical University, Faculty of Medicine, Department of Endocrinology and Metabolism - Trabzon, Turkey
| | - Irfan Nuhoglu
- Karadeniz Technical University, Faculty of Medicine, Department of Endocrinology and Metabolism - Trabzon, Turkey
| | - Mustafa Kocak
- Karadeniz Technical University, Faculty of Medicine, Department of Endocrinology and Metabolism - Trabzon, Turkey
| | - Halil Önder Ersöz
- Karadeniz Technical University, Faculty of Medicine, Department of Endocrinology and Metabolism - Trabzon, Turkey
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Tchang BG, Aras M, Wu A, Aronne LJ, Shukla AP. Long‐term weight loss maintenance with obesity pharmacotherapy: A retrospective cohort study. Obes Sci Pract 2022; 8:320-327. [PMID: 35664243 PMCID: PMC9159566 DOI: 10.1002/osp4.575] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022] Open
Abstract
Objective To determine the association of anti‐obesity medications (AOMs) with weight loss maintenance over 2 years. Methods This is a retrospective observational cohort study of adults treated for obesity between 1 April 2014 and 1 April 2016 at a tertiary academic weight management center and who completed 2 years of follow‐up. Main outcome measures were mean percent weight loss, percent of individuals who achieved clinically significant long‐term weight loss (≥5% weight loss over 2 years), and long‐term weight loss maintenance (achievement of ≥5% weight loss at 1 year and maintenance of the ≥5% reduction for the second year). Results Of the 1566 new patients, 421 completed 1‐ and 2‐year follow‐up appointments. Patients were mostly female and on average 51 years old; they weighed 100.1 kg and had a BMI of 35.8 kg/m2 at initial visit. Mean weight losses at 1 and 2 years were 10.1% and 10.2%, respectively. The proportion of patients who experienced ≥5% weight loss was 75.5% at 1 year and 72.9% at 2 years. Long‐term weight loss maintenance was achieved by 65.3% of patients. Almost all (96.2%) were on ≥1 AOM at 2 years, with metformin, phentermine, and topiramate among the most prescribed. AOM usage and older age demonstrated trends toward predicting weight loss maintenance over 2 years. Conclusions Long‐term weight loss maintenance was observed among adults with medically managed obesity who completed 2 years of follow‐up.
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Affiliation(s)
- Beverly G. Tchang
- Department of Medicine Division of Endocrinology, Diabetes and Metabolism Comprehensive Weight Control Center Weill Cornell Medicine New York New York USA
| | - Mohini Aras
- Department of Medicine Division of Endocrinology, Diabetes and Metabolism Comprehensive Weight Control Center Weill Cornell Medicine New York New York USA
| | - Alan Wu
- Division of Biostatistics and Epidemiology Department of Healthcare Policy & Research Weill Cornell Medicine New York New York USA
| | - Louis J. Aronne
- Department of Medicine Division of Endocrinology, Diabetes and Metabolism Comprehensive Weight Control Center Weill Cornell Medicine New York New York USA
| | - Alpana P. Shukla
- Department of Medicine Division of Endocrinology, Diabetes and Metabolism Comprehensive Weight Control Center Weill Cornell Medicine New York New York USA
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Metformin Reduces Potassium Currents and Prolongs Repolarization in Non-Diabetic Heart. Int J Mol Sci 2022; 23:ijms23116021. [PMID: 35682699 PMCID: PMC9181026 DOI: 10.3390/ijms23116021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Metformin is the first choice drug for the treatment of type 2 diabetes due to positive results in reducing hyperglycaemia and insulin resistance. However, diabetic patients have higher risk of ventricular arrhythmia and sudden cardiac death, and metformin failed to reduce ventricular arrhythmia in clinical trials. In order to explore the mechanisms responsible for the lack of protective effect, we investigated in vivo the effect of metformin on cardiac electrical activity in non-diabetic rats; and in vitro in isolated ventricular myocytes, HEK293 cells expressing the hERG channel and human induced pluripotent stem cells derived cardiomyocytes (hIPS-CMs). Surface electrocardiograms showed that long-term metformin treatment (7 weeks) at therapeutic doses prolonged cardiac repolarization, reflected as QT and QTc interval duration, and increased ventricular arrhythmia during the caffeine/dobutamine challenge. Patch-clamp recordings in ventricular myocytes isolated from treated animals showed that the cellular mechanism is a reduction in the cardiac transient outward potassium current (Ito). In vitro, incubation with metformin for 24 h also reduced Ito, prolonged action potential duration, and increased spontaneous contractions in ventricular myocytes isolated from control rats. Metformin incubation also reduced IhERG in HEK293 cells. Finally, metformin incubation prolonged action potential duration at 30% and 90% of repolarization in hIPS-CMs, which is compatible with the reduction of Ito and IhERG. Our results show that metformin directly modifies the electrical behavior of the normal heart. The mechanism consists in the inhibition of repolarizing currents and the subsequent decrease in repolarization capacity, which prolongs AP and QTc duration.
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Transdermal Delivery of Metformin Using Dissolving Microneedles and Iontophoresis Patches for Browning Subcutaneous Adipose Tissue. Pharmaceutics 2022; 14:pharmaceutics14040879. [PMID: 35456713 PMCID: PMC9029293 DOI: 10.3390/pharmaceutics14040879] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 01/27/2023] Open
Abstract
Obesity is a serious public health problem that is strongly associated with increased multiple comorbidities such as diabetes, cardiovascular disease, and some types of cancer. While current anti-obesity treatments have various issues, locally transforming energy-storing white adipose tissue (WAT) into energy-burning brown-like/beige adipose tissue, the so-called browning of WAT, has been suggested to enhance obesity treatment efficiency with minimized side effects. Metformin is a first-line antidiabetes drug and a potent activator of AMP-activated protein kinase. Emerging evidence has suggested that metformin might enhance energy expenditure via the browning of WAT and hence reduce body weight. Subcutaneous WAT is easier to access and has a stronger browning potential than other WAT depots. In this study, we used dissolvable poly (lactic-co-glycolic acid) microneedles (MN) to deliver metformin to the subcutaneous WAT in obese C57BL/6J mice with the assistance of iontophoresis (INT), and then investigated metformin-induced WAT browning and its subsequent thermogenesis effects. Compared with MN alone or INT alone, MN + INT had better anti-obesity activity, as indicated by decreasing body weight and fat gain, increased energy expenditure, decreased fat pad size, and improved energy metabolism through the browning of WAT. Browning subcutaneous WAT by delivering metformin and other browning agents using this MN + INT approach might combat obesity in an effective, easy, and safe regimen.
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Adams JH, Poehlmann J, Racine JL, Iruretagoyena JI, Eddy A, Hoppe KK, Stewart K, Rhoades J, Antony KM. Weight gain in pregnancy: can metformin steady the scales? J Matern Fetal Neonatal Med 2022; 35:9504-9510. [PMID: 35272547 DOI: 10.1080/14767058.2022.2044775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Metformin has been associated with modest weight reduction in the non-pregnant population. Our hypothesis is that metformin exposure will lead to a higher incidence of appropriate weight gain during pregnancy. STUDY DESIGN This was a retrospective cohort study in a single center between 2009 and 2019. We included all pregnant women with type 2 diabetes or prediabetes. We compared women exposed to metformin in any trimester. The primary outcome was appropriate weight gain defined by the Institute of Medicine guidelines. Secondary outcomes included excessive weight gain, weight loss, suspected fetal growth restriction (FGR), and mean birth weight. Adjusted odds ratios or group differences were calculated using logistic or linear regression, controlling for confounders. RESULTS Of 41,472 deliveries during the study period, 511 pregnancies met inclusion criteria. 284 pregnancies had no metformin exposure; 227 did have metformin exposure, of which 169 (72.2%) were initiated on metformin in the first trimester. Women exposed to metformin in any trimester were statistically not more likely to have appropriate weight gain (aOR 1.53 (95% CI 1.00-2.34, p = .048), but did have less excess weight gain (aOR 0.45, 95% CI 0.30-0.66, p < .001), and more maternal weight loss (aOR 2.17, 95% CI 1.18-3.98, p = .012) than the unexposed group. Women exposed to metformin in the first trimester of pregnancy were less likely to have excess weight gain (aOR 0.39, 95% CI 0.25-0.61, p < .001) and more likely to have maternal weight loss (aOR 2.56, 95% CI 1.30-5.07, p = .007) than the unexposed cohort. There was no difference in FGR (5.3% vs 2.5% p = .094) or mean birth weight (3235.6 vs 3352.4 gm p = .122) in the metformin exposed group vs non-exposed groups, respectively. CONCLUSIONS Metformin exposure in pregnancy was associated with less excess weight gain and a higher rate of weight loss. There was no difference in FGR or mean birth weight in metformin exposed neonates. This suggests that metformin may help avoid excess weight gain and its associated comorbidities.
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Affiliation(s)
- Jacquelyn H Adams
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - John Poehlmann
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - Jenna L Racine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - J Igor Iruretagoyena
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - April Eddy
- UnityPoint Health-Meriter Hospital, Madison, WI, USA
| | - Kara K Hoppe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - Katharina Stewart
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - Janine Rhoades
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - Kathleen M Antony
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
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Redmond IP, Shukla AP, Aronne LJ. Use of Weight Loss Medications in Patients after Bariatric Surgery. Curr Obes Rep 2021; 10:81-89. [PMID: 33492629 DOI: 10.1007/s13679-021-00425-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Weight regain after bariatric surgery is unfortunately a common occurrence. In this article, we have reviewed the data addressing this clinical problem focusing on pharmacological management of weight regain. RECENT FINDINGS Data from several small, non-randomized, retrospective, and prospective studies provide evidence that a number of pharmacological options, both FDA approved and off-label, are effective in mitigating and managing weight regain after bariatric surgery. There is a suggestion that the optimal time to initiate weight loss medications may be at the time of weight plateau, rather than after weight regain. Adjuvant pharmacotherapy can help treat weight regain after bariatric surgery. Future studies should investigate the optimal timing for starting weight loss medications, as well as the best medication or combinations of medicines, for managing postoperative weight regain in different patient groups, including those who have undergone different types of bariatric surgeries.
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Affiliation(s)
- Ilana P Redmond
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA.
| | - Alpana P Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA
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Song XM, Li BJ, Zhang YY, Ge WJ, Zhang SF, Cui WF, Li GS, Liang RF. Rutaecarpine enhances the anti-diabetic activity and hepatic distribution of metformin via up-regulation of Oct1 in diabetic rats. Xenobiotica 2021; 51:818-830. [PMID: 33952086 DOI: 10.1080/00498254.2021.1926573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diabetes mellitus is a chronic metabolic disorder with multiple complications, patients who receive metformin may have a simultaneous intake of herbal medicine containing rutaecarpine due to cardiovascular protection and hypolipidemic effects of rutaecarpine. There might be drug interactions between metformin and rutaecarpine. This study aimed to investigate the effects of rutaecarpine on the pharmacodynamics and pharmacokinetics of metformin in diabetic rats.The diabetic rat model was induced with high-fat diet and low dose streptozotocin. Metformin with or without rutaecarpine was administered by oral gavage for 42 days. Pharmacodynamics and pharmacokinetics parameters were evaluated.The pharmacodynamics results revealed that co-administration of rutaecarpine with metformin resulted in a remarkable reduction of serum glucose and lipid profiles in diabetic rats compared to metformin treated alone. The pharmacokinetics results showed that co-treatments of rutaecarpine with metformin did not affect the systemic exposure and renal distribution of metformin, but increased metformin concentration in liver. Furthermore, rutaecarpine increased Oct1-mediated metformin uptake into hepatocytes by upregulation of Oct1 expression in the liver.The above data indicate that rutaecarpine enhanced the anti-diabetic effect of metformin, which may be associated with the increased hepatic distribution of metformin through up-regulation of Oct1 in response to rutaecarpine.
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Affiliation(s)
- Xian-Mei Song
- Department of Pharmacology, Henan Medical College, Zhengzhou, China
| | - Bing-Jie Li
- Institute of Chinese Materia Medica, Henan Provincial Academy of Traditional Chinese Medicine, Zhengzhou, China.,School of Pharmacology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yan-Yan Zhang
- Department of Pharmacology, Henan Medical College, Zhengzhou, China
| | - Wen-Jing Ge
- Institute of Chinese Materia Medica, Henan Provincial Academy of Traditional Chinese Medicine, Zhengzhou, China.,School of Pharmacology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - She-Feng Zhang
- Institute of Chinese Materia Medica, Henan Provincial Academy of Traditional Chinese Medicine, Zhengzhou, China
| | - Wei-Feng Cui
- Institute of Chinese Materia Medica, Henan Provincial Academy of Traditional Chinese Medicine, Zhengzhou, China
| | - Geng-Sheng Li
- Institute of Chinese Materia Medica, Henan Provincial Academy of Traditional Chinese Medicine, Zhengzhou, China
| | - Rui-Feng Liang
- Institute of Chinese Materia Medica, Henan Provincial Academy of Traditional Chinese Medicine, Zhengzhou, China.,School of Pharmacology, Henan University of Traditional Chinese Medicine, Zhengzhou, China
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Ibrahim S, Lowe JR, Bramante CT, Shah S, Klatt NR, Sherwood N, Aronne L, Puskarich M, Tamariz L, Palacio A, Bomberg E, Usher M, King S, Benson B, Vojta D, Tignanelli C, Ingraham N. Metformin and Covid-19: Focused Review of Mechanisms and Current Literature Suggesting Benefit. Front Endocrinol (Lausanne) 2021; 12:587801. [PMID: 34367059 PMCID: PMC8342037 DOI: 10.3389/fendo.2021.587801] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 05/11/2021] [Indexed: 01/08/2023] Open
Abstract
Metformin is the first-line medication for type 2 diabetes, but it also has a long history of improved outcomes in infectious diseases, such as influenza, hepatitis C, and in-vitro assays of zika. In the current Covid-19 pandemic, which has rapidly spread throughout the world, 4 observational studies have been published showing reduced mortality among individuals with home metformin use. There are several potential overlapping mechanisms by which metformin may reduce mortality from Covid-19. Metformin's past anti-infectious benefits have been both against the infectious agent directly, as well as by improving the underlying health of the human host. It is unknown if the lower mortality suggested by observational studies in patients infected with Covid-19 who are on home metformin is due to direct activity against the virus itself, improved host substrate, or both.
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Affiliation(s)
- Sherehan Ibrahim
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jamie R. Lowe
- MPH Program, Dartmouth College, Hanover, NH, United States
| | - Carolyn T. Bramante
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Carolyn T. Bramante,
| | - Surbhi Shah
- Department of Medicine, Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN, United States
| | - Nichole R. Klatt
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Nancy Sherwood
- Department of Epidemiology, University of Minnesota, Minneapolis, MN, United States
| | - Louis Aronne
- Division of Endocrinology, Cornell Weill College of Medicine, New York, NY, United States
| | - Michael Puskarich
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Leonardo Tamariz
- Division of Cardiology and Miami VA Healthcare Administration, University of Miami, Miami, FL, United States
| | - Ana Palacio
- Division of Cardiology and Miami VA Healthcare Administration, University of Miami, Miami, FL, United States
| | - Eric Bomberg
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota, Minneapolis, MN, United States
| | - Michael Usher
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Samantha King
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Brad Benson
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Deneen Vojta
- UnitedHealth Group, Research and Development, Plymouth, MN, United States
| | - Chris Tignanelli
- Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Nicholas Ingraham
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, United States
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13
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Chukir T, Mandel L, Tchang BG, Al- Mulla NA, Igel LI, Kumar RB, Waitman J, Aronne LJ, Shukla AP. Metformin-induced weight loss in patients with or without type 2 diabetes/prediabetes: A retrospective cohort study. Obes Res Clin Pract 2021; 15:64-68. [DOI: 10.1016/j.orcp.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
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14
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Dembrowski GC, Barnes JW. Resolution of Metabolic syndrome with reduction of visceral adipose tissue in a 47 year old patient with Type 2 Diabetes Mellitus. Diabetes Metab Syndr 2020; 14:1001-1004. [PMID: 32622208 DOI: 10.1016/j.dsx.2020.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS), defined as a cluster of metabolic abnormalities including visceral adiposity, insulin resistance, hypertension, and dyslipidemia, now affects more than a third of adults in the United States highlighting the need for effective complementary approaches to current treatments. METHODS We present a case report of a 47-year-old man with a history of MetS and poorly controlled Type 2 Diabetes Mellitus (T2D) who completed a 20Lighter program (20L) including a very low calorie diet (VLCD). At the time of enrollment his BMI was 32.7, HbA1c was 9.6%, and prescription medication history included lisinopril, lovastatin, and metformin, glimepiride, and combination sitagliptin/metformin. RESULTS Fifteen weeks after beginning 20L (6 weeks after program completion) marked reduction of weight, visceral adipose tissue and normalization of HbA1C was seen, and all medications were withdrawn. CONCLUSIONS While longer follow-up is required, this case report shows that a comprehensive program including a relatively short period of nutritionally complete VLCD, followed by gradual return to moderate dietary lifestyle is capable of producing clinically significant improvements in health and quality of life in individuals with MetS and poorly controlled T2D.
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15
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Kumar RB, Aronne LJ. Iatrogenic Obesity. Endocrinol Metab Clin North Am 2020; 49:265-273. [PMID: 32418589 DOI: 10.1016/j.ecl.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity has been identified as a multifactorial disease with several determinants, including genetic predisposition, environmental influences, dietary patterns, and physical activity factors. Iatrogenic obesity, most commonly medication-induced weight gain, is often overlooked as a contributing factor to a patient's obesity. This article highlights medications known to cause weight gain.
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Affiliation(s)
- Rekha B Kumar
- Weill Cornell Medicine, Comprehensive Weight Control Center, 1165 York Avenue, New York, NY 10065, USA.
| | - Louis J Aronne
- Weill Cornell Medicine, Comprehensive Weight Control Center, 1165 York Avenue, New York, NY 10065, USA
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16
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Luo S, Lenon GB, Gill H, Yuen H, Yang AWH, Hung A, Nguyen LT. Do the Natural Chemical Compounds Interact with the Same Targets of Current Pharmacotherapy for Weight Management?-A Review. Curr Drug Targets 2020; 20:399-411. [PMID: 30173643 DOI: 10.2174/1389450119666180830125958] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity has become a worldwide health concern. Pharmacotherapies are now being introduced because lifestyle modifications alone are insufficient for weight management. The treatment outcomes of current approved anti-obesity agents are not satisfying due to drug-related intolerances. And so natural therapies including herbal medicines are popular alternatives for weight reduction; however, there are limited studies about their mechanism of actions. METHODS Five databases (PubMed, Scopus, Google Scholar, Science Direct, Proquest) were searched to investigate the targets and safety profiles of the current and past anti-obesity drugs that have been approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA) as well as the commonly used off-label agents. The targets for weight-loss natural products and their principle bioactive components have also been searched. Only articles in English were included. RESULTS The targets for current anti-obesity single agents include pancreatic lipase, Glucagon Like Peptide-1(GLP-1) receptor, and serotonin 2C (5-HT2C) receptor. Potential targets such as amylin, pancreatic alpha amylase, leptin receptor, melanocortin receptor 4 receptor (MC4R), Peroxisome Proliferator- Activated Receptors gamma (PPAR γ), endocannabinoid 1 (CB1) receptor and Adenosine Monophosphate (AMP)-Activated Protein Kinase (AMPK) were discussed in various studies. Natural compounds have been found to interact with targets like pancreatic lipase, pancreatic alpha amylase, AMPK and PPAR γ to achieve weight reduction. CONCLUSION Current pharmacotherapies and natural chemical compounds do act on same targets. Further investigations on the interactions between herbal compounds and the above targets are essential for the development of novel weight-loss therapies.
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Affiliation(s)
- Shiqi Luo
- School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Victoria 3083, Australia
| | - George Binh Lenon
- School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Victoria 3083, Australia
| | - Harsharn Gill
- School of Sciences, RMIT University, Bundoora West Campus, Victoria 3083, Australia
| | - Heidi Yuen
- School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Victoria 3083, Australia
| | - Angela Wei Hong Yang
- School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Victoria 3083, Australia
| | - Andrew Hung
- School of Sciences, RMIT University, Bundoora West Campus, Victoria 3083, Australia
| | - Linh Toan Nguyen
- Department of Pathophysiology, Vietnam Military Medical University, Hanoi, Vietnam
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17
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Barenbaum SR, Mathews SE, Saunders KH, Minero G, Mauer E, Aronne LJ, Shukla AP. Utility of BMIQ, a novel web-based weight management programme, at an academic weight management centre. Obes Sci Pract 2020; 6:134-138. [PMID: 32313671 PMCID: PMC7156832 DOI: 10.1002/osp4.393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND BMIQ is a customizable online platform used to deliver evidence-based behavioural management that complements office visits with healthcare providers. BMIQ offers educational materials, meal plans and tracking tools for patients, and remote monitoring and guidance for physicians. In this retrospective chart review, the implementation and utility of BMIQ was assessed in patients treated at the Comprehensive Weight Control Center (CWCC) at Weill Cornell Medicine. METHODS The study included all new patients seen at the CWCC between 9/1/2016 and 6/1/2017 who enrolled in BMIQ. Use of BMIQ was assessed by the number of enrolled patients who activated their account and viewed BMIQ sessions. Demographics, comorbidities, medications, and weight change during 6-month follow-up were obtained from the electronic medical records. RESULTS Of the 495 new patients enrolled in BMIQ, 217 met the inclusion criteria of 6-month follow-up. The mean age was 50.2 (±13.1) and 72% (n = 157) were female. Sixty-four percent (n = 138) activated their BMIQ account and viewed greater than or equal to 1 BMIQ session. The average number of physician and registered dietitian visits were 3.5 (±1.1) and 1.9 (±1.6), respectively. The average number of weight loss medications was 1.6 with metformin being the most commonly prescribed (76%). Mean weight loss at 6 months was 7.0 ± 5.9%; 59% achieved greater than or equal to 5% weight loss and 28% achieved greater than or equal to 10% weight loss. The total number of physician visits and weight-loss pharmacotherapies used were significant predictors of patients achieving greater than or equal to 5% weight loss. Regular BMIQ usage was an independent predictor of patients achieving both greater than or equal to 5% and greater than or equal to 10% weight loss at 6 months. CONCLUSION Clinically significant weight loss was achieved in the majority of patients with limited in-clinic physician and registered dietitian follow-up in combination with BMIQ. This retrospective study demonstrates the utility of online behavioural therapy as part of a medical weight management intervention.
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Affiliation(s)
- Sarah R. Barenbaum
- Comprehensive Weight Control Center, Division of EndocrinologyDiabetes, and Metabolism, Weill Cornell MedicineNew YorkNew York
| | - Sherin E. Mathews
- Comprehensive Weight Control Center, Division of EndocrinologyDiabetes, and Metabolism, Weill Cornell MedicineNew YorkNew York
| | - Katherine H. Saunders
- Comprehensive Weight Control Center, Division of EndocrinologyDiabetes, and Metabolism, Weill Cornell MedicineNew YorkNew York
| | | | - Elizabeth Mauer
- Department of Healthcare Policy and ResearchWeill Cornell MedicineNew YorkNew York
| | - Louis J. Aronne
- Comprehensive Weight Control Center, Division of EndocrinologyDiabetes, and Metabolism, Weill Cornell MedicineNew YorkNew York
| | - Alpana P. Shukla
- Comprehensive Weight Control Center, Division of EndocrinologyDiabetes, and Metabolism, Weill Cornell MedicineNew YorkNew York
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Derkach KV, Romanova IV, Zorina II, Bakhtyukov AA, Perminova AA, Ivantsov AO, Shpakov AO. Effect of High-Dose Metformin on the Metabolic Parameters and Functional State of the Liver of Agouti Mice with Melanocortin Obesity. ADVANCES IN GERONTOLOGY 2020. [DOI: 10.1134/s2079057020010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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19
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Soliman GF, Hashem G, Fawzy MG, Ibrahim W. Neuroprotective Effects of Metformin Versus Selegiline on Parkinson’s Disease Model By Reserpine through the Interrelation of α Synuclein and Antioxidants on Behavioral Changes in Rats. EGYPTIAN JOURNAL OF BASIC AND CLINICAL PHARMACOLOGY 2019. [DOI: 10.32527/2019/101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ghada Farouk Soliman
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt
| | - Ghada Hashem
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt
| | - Monica Gamal Fawzy
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt
| | - Walaa Ibrahim
- Department Medical Biochemistry, Faculty of Medicine, Cairo University, Egypt
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20
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Rosen J, Darwin E, Tuchayi SM, Garibyan L, Yosipovitch G. Skin changes and manifestations associated with the treatment of obesity. J Am Acad Dermatol 2019; 81:1059-1069. [DOI: 10.1016/j.jaad.2018.10.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
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21
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Derkach K, Zakharova I, Zorina I, Bakhtyukov A, Romanova I, Bayunova L, Shpakov A. The evidence of metabolic-improving effect of metformin in Ay/a mice with genetically-induced melanocortin obesity and the contribution of hypothalamic mechanisms to this effect. PLoS One 2019; 14:e0213779. [PMID: 30870482 PMCID: PMC6417728 DOI: 10.1371/journal.pone.0213779] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/19/2019] [Indexed: 12/16/2022] Open
Abstract
In diet-induced obesity, metformin (MF) has weight-lowering effect and improves glucose homeostasis and insulin sensitivity. However, there is no information on the efficiency of MF and the mechanisms of its action in melanocortin-type obesity. We studied the effect of the 10-day treatment with MF at the doses of 200, 400 and 600 mg/kg/day on the food intake and the metabolic and hormonal parameters in female C57Bl/6J (genotype Ay/a) agouti-mice with melanocortin-type obesity, and the influence of MF on the hypothalamic signaling in obese animals at the most effective metabolic dose (600 mg/kg/day). MF treatment led to a decrease in food intake, the body and fat weights, the plasma levels of glucose, insulin and leptin, all increased in agouti-mice, to an improvement of the lipid profile and glucose sensitivity, and to a reduced fatty liver degeneration. In the hypothalamus of obese agouti-mice, the leptin and insulin content was reduced and the expression of the genes encoding leptin receptor (LepR), MC3- and MC4-melanocortin receptors and pro-opiomelanocortin (POMC), the precursor of anorexigenic melanocortin peptides, was increased. The activities of AMP-activated kinase (AMPK) and the transcriptional factor STAT3 were increased, while Akt-kinase activity did not change from control C57Bl/6J (a/a) mice. In the hypothalamus of MF-treated agouti-mice (10 days, 600 mg/kg/day), the leptin and insulin content was restored, Akt-kinase activity was increased, and the activities of AMPK and STAT3 were reduced and did not differ from control mice. In the hypothalamus of MF-treated agouti-mice, the Pomc gene expression was six times higher than in control, while the gene expression for orexigenic neuropeptide Y was decreased by 39%. Thus, we first showed that MF treatment leads to an improvement of metabolic parameters and a decrease of hyperleptinemia and hyperinsulinaemia in genetically-induced melanocortin obesity, and the specific changes in the hypothalamic signaling makes a significant contribution to this effect of MF.
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Affiliation(s)
- Kira Derkach
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Irina Zakharova
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Inna Zorina
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Andrey Bakhtyukov
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Irina Romanova
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Liubov Bayunova
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexander Shpakov
- Department of Molecular Endocrinology and Neurochemistry, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
- * E-mail:
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22
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Carvalho V, Martins J. Could weight loss contribute to the improved mobility with metformin in patients with myotonic dystrophy type 1? Brain 2019; 142:e5. [DOI: 10.1093/brain/awy335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vanessa Carvalho
- Department of Neurology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - João Martins
- Department of Neurology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
- Electromyography and Nerve Conduction Studies Laboratory, Department of Neurology, Hospital Pedro Hispano, Matosinhos Local Health Unit, Matosinhos, Portugal
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23
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Zemel MB, Kolterman O, Rinella M, Vuppalanchi R, Flores O, Barritt AS, Siddiqui M, Chalasani N. Randomized Controlled Trial of a Leucine-Metformin-Sildenafil Combination (NS-0200) on Weight and Metabolic Parameters. Obesity (Silver Spring) 2019; 27:59-67. [PMID: 30569637 DOI: 10.1002/oby.22346] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/20/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Leucine was previously demonstrated to allosterically activate mammalian sirtuin 1 and synergize with other sirtuin 1/AMP-activated protein kinase/nitric oxide pathway activators to modulate energy metabolism. The objective of this study was to evaluate the effects of a triple combination of leucine, metformin, and sildenafil (NS-0200) on body weight and obesity comorbidities in a phase 2 randomized trial. METHODS A total of 91 subjects with obesity were randomized to placebo, low dose (1.1 g leucine/0.5 g metformin/0.5 mg sildenafil), or high dose (1.1 g leucine/0.5 g metformin/1.0 mg sildenafil) twice daily for 16 weeks. Seventy subjects completed the trial and met all a priori compliance criteria. Hypertensive (n = 35) and hypertriglyceridemic (n = 22) subcohorts were also analyzed. RESULTS NS-0200 dose-responsively reduced weight; high dose reduced weight by 2.4 and 5.0 kg in the full and high-triglyceride cohorts, respectively (P < 0.0001). High-dose NS-0200 treatment also decreased blood pressure (-5.5 mm Hg diastolic pressure; P = 0.011), with greater effects among hypertensive subjects. NS-0200 also significantly reduced triglycerides and hemoglobin A1c. Significant improvement in ≥ 2 comorbidities was exhibited by 54% of subjects in the high-dose arm versus 5% of placebo subjects (P = 0.0009). Treatment-emergent adverse events did not significantly differ among groups. CONCLUSIONS These data support further study of NS-0200 as a therapy for obesity and associated comorbidities.
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Affiliation(s)
| | | | - Mary Rinella
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raj Vuppalanchi
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Illinois, USA
| | | | - A Sidney Barritt
- Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Mohammad Siddiqui
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Illinois, USA
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24
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Derkach KV, Sukhov IB, Bondareva VM, Shpakov AO. Effect of Metformin on Metabolic Parameters and Hypothalamic Signaling Systems in Rats with Obesity Induced by a High-Carbohydrate and High-Fat Diet. ADVANCES IN GERONTOLOGY 2018. [DOI: 10.1134/s2079057018030037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Ma W, Chen J, Meng Y, Yang J, Cui Q, Zhou Y. Metformin Alters Gut Microbiota of Healthy Mice: Implication for Its Potential Role in Gut Microbiota Homeostasis. Front Microbiol 2018; 9:1336. [PMID: 29988362 PMCID: PMC6023991 DOI: 10.3389/fmicb.2018.01336] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/31/2018] [Indexed: 01/27/2023] Open
Abstract
In recent years, the first-line anti-diabetic drug metformin has been shown to be also useful for the treatment of other diseases like cancer. To date, few reports were about the impact of metformin on gut microbiota. To fully understand the mechanism of action of metformin in treating diseases other than diabetes, it is especially important to investigate the impact of long-term metformin treatment on the gut microbiome in non-diabetic status. In this study, we treated healthy mice with metformin for 30 days, and observed 46 significantly changed gut microbes by using the 16S rRNA-based microbiome profiling technique. We found that microbes from the Verrucomicrobiaceae and Prevotellaceae classes were enriched, while those from Lachnospiraceae and Rhodobacteraceae were depleted. We further compared the altered microbiome profile with the profiles under various disease conditions using our recently developed comparative microbiome tool known as MicroPattern. Interestingly, the treatment of diabetes patients with metformin positively correlates with colon cancer and type 1 diabetes, indicating a confounding effect on the gut microbiome in patients with diabetes. However, the treatment of healthy mice with metformin exhibits a negative correlation with multiple inflammatory diseases, indicating a protective anti-inflammatory role of metformin in non-diabetes status. This result underscores the potential effect of metformin on gut microbiome homeostasis, which may contribute to the treatment of non-diabetic diseases.
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Affiliation(s)
- Wei Ma
- Department of Biomedical Informatics, School of Basic Medical Sciences, Peking University, Beijing, China.,Ministry of Education Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China.,Central Laboratory, PLA Navy General Hospital, Beijing, China
| | - Ji Chen
- Ministry of Education Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China.,Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yuhong Meng
- Ministry of Education Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China.,Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Jichun Yang
- Ministry of Education Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China.,Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Qinghua Cui
- Department of Biomedical Informatics, School of Basic Medical Sciences, Peking University, Beijing, China.,Ministry of Education Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China.,Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yuan Zhou
- Department of Biomedical Informatics, School of Basic Medical Sciences, Peking University, Beijing, China.,Ministry of Education Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Beijing, China
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26
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Igel LI, Saunders KH, Fins JJ. Why Weight? An Analytic Review of Obesity Management, Diabetes Prevention, and Cardiovascular Risk Reduction. Curr Atheroscler Rep 2018; 20:39. [PMID: 29785665 DOI: 10.1007/s11883-018-0740-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW In this review, we examine one of the ironies of American health care-that we pay more for disease management than disease prevention. Instead of preventing type 2 diabetes (T2DM) by treating its precursor, obesity, we fail to provide sufficient insurance coverage for weight management only to fund the more costly burden of overt T2DM. RECENT FINDINGS There is a vital need for expanded insurance coverage to help foster a weight-centric approach to T2DM management. This includes broader coverage of anti-diabetic medications with evidence of cardiovascular risk reduction and mortality benefit, anti-obesity pharmacotherapy, bariatric surgery, weight loss devices, endoscopic bariatric therapies, and lifestyle interventions for the treatment of obesity. The fundamental question to ask is why weight? Why wait to go after obesity until its end-stage sequelae cause intractable conditions? Instead of managing the complications of T2DM, consider preventing them by tackling obesity.
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Affiliation(s)
- L I Igel
- Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA.
| | - K H Saunders
- Division of Endocrinology, Diabetes and Metabolism, Comprehensive Weight Control Center, Weill Cornell Medical College, 1165 York Avenue, New York, NY, 10065, USA
| | - J J Fins
- The E. William Davis, Jr., M.D. Professor of Medical Ethics, Professor of Medicine Chief, Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
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27
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A reappraisal on metformin. Regul Toxicol Pharmacol 2018; 92:324-332. [DOI: 10.1016/j.yrtph.2017.12.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022]
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28
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Cardiovascular Outcome Trials of Diabetes and Obesity Drugs: Implications for Conditional Approval and Early Phase Clinical Development. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0209-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kenawy S, Hegazy R, Hassan A, El-Shenawy S, Gomaa N, Zaki H, Attia A. Involvement of insulin resistance in D-galactose-induced age-related dementia in rats: Protective role of metformin and saxagliptin. PLoS One 2017; 12:e0183565. [PMID: 28832656 PMCID: PMC5568415 DOI: 10.1371/journal.pone.0183565] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/07/2017] [Indexed: 01/05/2023] Open
Abstract
Age-related dementia is one of the most devastating disorders affecting the elderly. Recently, emerging data suggest that impaired insulin signaling is the major contributor in the development of Alzheimer's dementia (AD), which is the most common type of senile dementia. In the present study, we investigated the potential therapeutic effects of metformin (Met) and saxagliptin (Saxa), as insulin sensitizing agents, in a rat model of brain aging and AD using D-galactose (D-gal, 150 mg/kg/day, s.c. for 90 successive days). Six groups of adult male Wistar rats were used: normal, D-gal, Met (500 mg/kg/day, p.o), and Saxa (1 mg/kg/day, p.o) control groups, as well as D-gal/Met and D-gal/Sax treated groups. Impaired learning and memory function was observed in rats treated with D-gal using Morris water maze test. Biochemical and histopathological findings also revealed some characteristic changes of AD in the brain that include the increased content of acetylcholine, glutamate, and phosphorelated tau, as well as deposition of amyloid plaques and neurofibrillary tangles. Induction of insulin resistance in experimentally aged rats was evidenced by increased blood glycated hemoglobin, brain contents of insulin and receptors for advanced glycated end-products, as well as decreased brain insulin receptor level. Elevation of oxidative stress markers and TNF-α brain content was also demonstrated. Met and Saxa, with a preference to Met, restored the normal memory and learning functions in rats, improved D-gal-induced state of insulin resistance, oxidative stress and inflammation, and ameliorated the AD biochemical and histopathological alterations in brain tissues. Our findings suggest that D-gal model of aging results in a diminishing of learning and memory function by producing a state of impaired insulin signaling that causes a cascade of deleterious events like oxidative stress, inflammation, and tau hyper-phosphorylation. Reversing of these harmful effects by the use of insulin-sensitizing drugs like Met and Saxa suggests their involvement in alleviation insulin resistance as the underlying pathology of AD and hence their potential use as anti-dementia drugs.
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Affiliation(s)
- Sara Kenawy
- Pharmacology Department, Medical division, National Research Centre, Giza, Egypt
| | - Rehab Hegazy
- Pharmacology Department, Medical division, National Research Centre, Giza, Egypt
- * E-mail:
| | - Azza Hassan
- Pathology Department, Faculty of Veterinary Medicine, Cairo University, Giza, Egypt
| | - Siham El-Shenawy
- Pharmacology Department, Medical division, National Research Centre, Giza, Egypt
| | - Nawal Gomaa
- Pharmacology Department, Medical division, National Research Centre, Giza, Egypt
| | - Hala Zaki
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Amina Attia
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Abstract
The global pandemic of obesity and overweight now affects between 2.8 and 3.5 billion of the world population and shows no signs of abatement. Treatment for what is now recognized as a chronic disease includes pharmacotherapy, considered an essential component of comprehensive therapy. New drug discovery is robust, but the pace of the US Food and Drug Administration approval for obesity drugs has been glacial, and only a handful of approved drugs are available for treating obesity. In the last 20 years, the US Food and Drug Administration has approved 208 drugs for cancer, 118 for cardiovascular diseases, 168 for neurological diseases, and 223 endocrinologic drugs, but only 6 for obesity, 2 of which have been taken off market. Currently, there are only 9 drugs approved by the FDA for obesity treatment. US physicians have turned to off-label drug use in their effort to care for increasing numbers of patients with excess adiposity. Phentermine is the most commonly used drug for treating obesity. Although approved only for short-term use, US physicians have used it successfully for long-term since its initial approval in 1959. This drug, used off-label for long-term, has proven to be safe and effective, far safer than the disease it is used to treat. Phentermine and diethylpropion, an equally safe but somewhat less effective drug, are both generic and therefore inexpensive. These drugs have been maligned inappropriately because their two-dimensional structure diagrams resemble amphetamine and also because of unproven presumptions about their potential adverse effects. In the face of an increasing epidemic, worldwide obese and overweight patients deserve effective treatment that prescribing these drugs could provide, if rehabilitated and used more frequently. US physicians will likely continue to use any drug proven useful off-label for this illness until such time as more effective drugs are approved.
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Affiliation(s)
- Ed J Hendricks
- Center for Weight Management, Roseville and Sacramento, CA, USA
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Igel LI, Kumar RB, Saunders KH, Aronne LJ. Practical Use of Pharmacotherapy for Obesity. Gastroenterology 2017; 152:1765-1779. [PMID: 28192104 DOI: 10.1053/j.gastro.2016.12.049] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 01/07/2023]
Abstract
Obesity management requires a multidisciplinary approach, as there are many factors that contribute to the development of obesity, as well as the preservation of excess weight once it has been gained. Diet, exercise, and behavior modification are key components of treatment. In addition to lifestyle changes, weight gain secondary to medications is an important modifiable risk factor. Even after appropriate lifestyle modification, and medication adjustments (where possible) to avoid agents that can contribute to weight gain, many patients are still unable to achieve clinically meaningful weight loss. Pharmacotherapy for obesity management can fill an important role for these patients. This article will review medications that can lead to weight gain and potential alternatives, currently approved anti-obesity medications and best practices to individualize the selection process, and the use of testosterone in men with hypogonadism and obesity.
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Affiliation(s)
- Leon I Igel
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, New York.
| | - Rekha B Kumar
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, New York
| | - Katherine H Saunders
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, New York
| | - Louis J Aronne
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medical College, New York, New York
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32
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Nutrients in Energy and One-Carbon Metabolism: Learning from Metformin Users. Nutrients 2017; 9:nu9020121. [PMID: 28208582 PMCID: PMC5331552 DOI: 10.3390/nu9020121] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023] Open
Abstract
Metabolic vulnerability is associated with age-related diseases and concomitant co-morbidities, which include obesity, diabetes, atherosclerosis and cancer. Most of the health problems we face today come from excessive intake of nutrients and drugs mimicking dietary effects and dietary restriction are the most successful manipulations targeting age-related pathways. Phenotypic heterogeneity and individual response to metabolic stressors are closely related food intake. Understanding the complexity of the relationship between dietary provision and metabolic consequences in the long term might provide clinical strategies to improve healthspan. New aspects of metformin activity provide a link to many of the overlapping factors, especially the way in which organismal bioenergetics remodel one-carbon metabolism. Metformin not only inhibits mitochondrial complex 1, modulating the metabolic response to nutrient intake, but also alters one-carbon metabolic pathways. Here, we discuss findings on the mechanism(s) of action of metformin with the potential for therapeutic interpretations.
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Bramlage P, Bluhmki T, Fleischmann H, Kaltheuner M, Beyersmann J, Holl RW, Danne T. Determinants of weight change in patients on basal insulin treatment: an analysis of the DIVE registry. BMJ Open Diabetes Res Care 2017; 5:e000301. [PMID: 28176957 PMCID: PMC5278215 DOI: 10.1136/bmjdrc-2016-000301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We aimed to describe patterns of weight change in insulin-naive patients with type 2 diabetes mellitus (T2DM) starting basal insulin (BI) treatment. RESEARCH DESIGN AND METHODS Diabetes Versorgungs-Evaluation (DIVE) is an observational, multicenter, prospective registry in patients with T2DM. Patients were divided into those initiating BI therapy for the first time (with optional oral antidiabetic drugs (OADs)) and those initiating OADs only (OADo). RESULTS 521 patients were included in the analysis, 113 in the BI arm and 408 in the OADo arm. Relative to baseline, the BI group gained an average of 0.98±7.1 kg at 1 year, compared with a loss of 1.52±11.8 kg in the OADo group (p<0.001). This difference remained statistically significant when expressed as a proportional change from baseline (+0.014±0.08 vs -0.015±0.12, respectively (p<0.001)). Baseline weight (regression coefficient (RC) 0.89; 95% CI 0.81 to 0.97; p<0.001) and diabetes duration (RC 2.52; 95% CI 0.53 to 4.52; p=0.01) were the only factors identified as significant predictors of weight gain between baseline and 1 year follow-up in BI patients. CONCLUSIONS Though BI therapy leads to modest weight gain over the subsequent year, this may be limited by BI initiation at an early stage of the disease. As such, delaying the start of insulin therapy based on fears of weight gain appears counter-productive, and should be reconsidered.
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Affiliation(s)
- Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany
| | | | | | - Matthias Kaltheuner
- winDiab GmbH, Düsseldorf, Germany
- Gemeinschaftspraxis Kaltheuner—v. Boxberg, Leverkusen, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Neuherberg, Germany
| | - Thomas Danne
- Kinder- und Jugendkrankenhaus “AUF DER BULT”, Hannover, Germany
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Fiesselmann A, Wiesner T, Fleischmann H, Bramlage P. Real-world therapeutic benefits of patients on insulin glargine versus NPH insulin. Acta Diabetol 2016; 53:717-26. [PMID: 27093968 DOI: 10.1007/s00592-016-0862-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
AIMS The addition of a single injection of insulin to the oral drugs (basal supported oral therapy; BOT) has been shown to greatly reduce blood glucose levels. The intermediate-acting NPH insulin (NPH) and the long-acting insulin glargine (Lantus(®)) have been compared for use in BOT in numerous clinical trials; however, their efficacy and safety in a real-life setting have not been described. METHODS TIP (therapeutic benefits of patients on insulin glargine vs. NPH insulin being poorly controlled on prior short-time basal-insulin supported therapy with NPH insulin or insulin glargine) is a non-interventional, multicentre, observational study over 24 weeks. A total of 2629 patients were enrolled and 1931 were fully evaluable (1614 insulin glargine, 303 NPH insulin). Propensity scoring (PSM) was used to match 570 patients into 2 similar cohorts of 285 patients. RESULTS In the PSM cohort, a slightly greater reduction in FBG and HbA1c levels was seen in the insulin glargine group compared to the NPH group. A weight loss, which was slightly more pronounced in insulin glargine patients despite receiving a lower insulin dose relative to the NPH group, was seen in both the groups. Additionally, hypoglycaemia, including nocturnal and severe events, was more prevalent in the patients receiving BOT with NPH. The occurrence of new micro- or macro-vascular complications and adverse events was low for both groups. A large proportion of patients changed from NPH therapy to insulin glargine therapy during the study, which was mainly attributable to insufficient glucose modulation. Improvements in quality of life and treatment satisfaction were found for both types of insulin. CONCLUSIONS This observational study provides evidence from a real-life setting that BOT with insulin glargine provides slightly greater reductions in weight, FBG and HbA1c levels, with a lower risk of hypoglycaemia than patients receiving NPH. This conclusion indicates that insulin glargine may be preferable to NPH insulin for BOT.
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Affiliation(s)
| | - Tobias Wiesner
- MVZ Stoffwechselmedizin Leipzig, Prager Str. 34, 04317, Leipzig, Germany
| | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Menzelstrasse 21, 15831, Mahlow, Germany.
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Vesely JM, Pronk NP, Kottke TE, Marshall PS. Obesity Treatment at HealthPartners: Adaptation of Clinical Guidelines into Systems for Practice Operations. Curr Obes Rep 2016; 5:312-9. [PMID: 27342444 DOI: 10.1007/s13679-016-0220-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this paper is to describe how HealthPartners health system in Minneapolis, MN, has translated a clinical guideline for obesity among adults into an efficient care delivery practice operations system. Based on a foundation provided by the physician-led Institute of Clinical Systems Improvement (ICSI)-developed Prevention and Management of Obesity for Adults Health Care Guideline, HealthPartners adapted the guideline into an electronic health record-based "Smart Set" that provides frontline physicians with the information, treatment options, and referral steps necessary to care for their patients with obesity. Additional context is provided in terms of insurance coverage and systems-based resources designed to prevent and treat obesity for adults.
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Affiliation(s)
- Jennifer M Vesely
- Obesity Medicine and Medical Weight Management, Park Nicollet Health Services, HealthPartners, 8240 Golden Valley Drive, Golden Valley, Minneapolis, MN, USA
| | - Nicolaas P Pronk
- HealthPartners, 8170 33rd Avenue South Bloomington, Minneapolis, MN, 55425, USA.
| | - Thomas E Kottke
- HealthPartners, 8170 33rd Avenue South Bloomington, Minneapolis, MN, 55425, USA
| | - Peter S Marshall
- HealthPartners, 8170 33rd Avenue South Bloomington, Minneapolis, MN, 55425, USA
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