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Peter C. Y. Tong, MBBS,PhD,MRCP; Zoe S. K. Lee, PhD; Man-Mei Sea, MPhil; Chun-Chung Chow, MBBS,FRCP; Gary T. C. Ko, MBChB,FRCPI; Wing-Bun Chan, MBChB,MRCP; Wing-Yee So, MBChB,MRCP; Ronald C. W. Ma, MBChB,MRCP; Risa Ozaki, MBChB,MRCP; Jean Woo, MD,FRCP; Clive S. Cockram, MD,FRCP; Juliana C. N. Chan, MD,FRCP

Arch Intern Med. 2002;162:2428-2435.

Background  We examined the weight-losing effect of orlistat treatment on insulin sensitivity and cardiovascular risk factors in a group of severely obese young Chinese patients with or without type 2 diabetes mellitus.

Methods  Obese patients with diabetes (n = 33) and obese nondiabetic patients (n = 27) were given orlistat, 120 mg 3 times daily, without a concomitant hypocaloric diet for 6 months (body mass index [calculated as weight in kilograms divided by the square of height in meter; kg/m²] range, 27.8-47.4). The efficacy measures were (1) insulin sensitivity indices derived from the homeostasis model assessment and a composite measure of whole-body insulin sensitivity index; (2) glycemic control; (3) cardiovascular risk factors, including anthropometry, blood pressure, lipid profiles, and albuminuria; and (4) body composition determined by dual-energy x-ray absorptiometry.

Results  At baseline, patients with diabetes had lower body mass index and percentage of body fat but higher waist-hip ratios and were more insulin resistant. Orlistat therapy reduced body weight, waist and hip circumferences, percentage of total body fat, blood pressure, fasting plasma glucose and lipid levels, albuminuria, and insulin sensitivity indices in both groups (all, P<.05). Despite less weight reduction, we found a greater percentage of reduction from baseline in glycosylated hemoglobin level (-11.6% vs -3.6%; P<.001), fasting plasma glucose level (-18.2% vs -5.0%; P<.001), and systolic blood pressure (-7.1% vs -3.1%; P = .02) in patients with diabetes. Obese subjects without diabetes had greater improvements in triglyceride levels, albuminuria, and the homeostasis model assessment (all, P<.01).

Conclusion  Short-term orlistat treatment without the use of a hypocaloric diet significantly improved insulin sensitivity and cardiovascular risk profiles in severely obese Chinese patients with or without type 2 diabetes.

From the Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. Dr Lee was previously an employee of Roche Hong Kong Ltd, Causeway Bay, Hong Kong.

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