[Mechanisms for weight gain during blood glucose normalization].
Secondary failure to dietary and maximal oral treatment leads to insulin therapy in type 2 diabetic patients. However, weight gain is a frequent side effect of insulin therapy in these patients. Mechanisms for this weight gain are complex. Insulin 1) reduces glycosuria and its caloric expenditure; 2) stimulates the stockage of fatty acids into triglycerides in adipose tissue, thus favoring an increase in adipose mass; 3) yields a positive nitrogen balance through an inhibition of muscle proteolysis, thus favoring an increase in lean mass. Most studies report an average 6 kg weight gain during the first year following the initiation of insulin therapy in type 2 diabetic patients. Analysing body composition variations shows that weight gain results both from an increase in fat mass (mean 63%) and an increase in lean mass (mean 37%). Preexisting obesity does not influence this weight gain. Finally, the 10 year-follow up of UKPDS showed a beneficial effect of insulin therapy on microangiopathy prevention, without increasing cardiovascular mortality as compared with type 2 diabetic patients on oral treatment. Thus, while weight gain seems mandatory, it should not refrain from initiating insulin therapy in poorly controlled type 2 diabetic patients, as its expected beneficial effects on the prevention of microangiopathy seem well established.
Laville
M
M
Service d'Endocrinologie, Diabétologie, Nutrition Hôpital Edouard Herriot, Lyon.
Andreelli
F
F
D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D015430:Weight Gain
D001786:Blood Glucose; D007328:Insulin