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112 COMPARING WEIGHT LOSS AND CARDIOVASCULAR BENEFITS AMONG TYPE 2 DIABETICS PRESCRIBED WITH VARIOUS ORAL ANTIHYPERGLYCEMIC MEDICATIONS AND HYPOCALORIC DIETS.
  1. A. Wong1
  1. 1Stanford University, Stanford, CA.

Abstract

This clinical study was conducted to determine which of three types of antihyperglycemic medications is best for overweight/obese insulin-resistant type 2 diabetics in terms of achieving weight loss and cardiovascular benefits: thiazolidenediones (TZDs), sulfonylurea compounds (SUs), or metformin (Met). This is especially important since each drug uses a different mechanism for decreasing blood glucose. Whereas TZDs are insulin sensitizers, SUs are insulin secretogogues and Met is insulin neutral. We hypothesize that for a similar amount of weight loss, the cardiovascular benefits would be greater for those on TZDs. Subjects' clinical and laboratory data were obtained at baseline, and insulin-mediated glucose uptake was quantified by the previously validated steady-state plasma glucose (SSPG) test. Glucose and insulin were infused at concentrations similar in all subjects, and endogenous insulin secretion was suppressed by sandostatin. By steady state (150-180 minutes), plasma insulin concentrations were approximately 60 μU/mL, but glucose concentrations differed, reflecting the ability of the insulin to dispose of the glucose load. Subjects were then randomized to one of the three classes of study drugs. Once blood glucose concentrations were stable, subjects began a hypocaloric diet (−750 kcal/d), with weekly monitoring by study dietitians. After 4 months, the same metabolic measurements were collected, and statistical analysis was performed to compare pre and post values within and among the drug groups. Results demonstrated statistical significance within each class of drug for the weight loss, SSPG, blood pressure, and cholesterol categories (p values were all < .05). But even though each drug significantly improved these metabolic measurements, comparison of changes between groups showed that neither drug made such improvements to a significantly greater degree than another (p values comparing delta values among the three drug groups were all greater than .05). Thus, even though each class of antihyperglycemic medication works differently in the body, all help decrease insulin resistance levels by allowing weight loss and cardiovascular risk reduction in type 2 diabetics. There is no compelling evidence why one should be chosen over the other to combat the insulin resistance syndrome.

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