title: Intentional weight loss and dose reductions of anti-diabetic medications--a retrospective cohort study.
abstract: OBJECTIVE
  Intentional weight loss, primarily by improving insulin resistance, is known to decrease the need for anti-diabetic medications. In this study, we assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment.
  
  
  METHODS
  Case records of 50 overweight or obese patients with DM who successfully decreased dosage or discontinued diabetes medications after losing weight via attendance at two University-based, outpatient weight management centers were analyzed. Follow-up visits, weight reduction interventions, and decisions for dose reductions or discontinuation of medications were individualized to patient needs by the treating physician.
  
  
  RESULTS
  Mean starting BMI was 35 kg/m(2), mean age 53.4 years, and 58% were male. All 50 used at least one anti-diabetic medication (30 metformin, 39 sulfonylureas, 31 insulin, 21 sitagliptin) to manage blood sugar. Mean duration of follow-up was 30.2 months. Mean weight loss was 10.8 ± 4.1 kgs (11.1% of initial body weight ± 4.7%). 22/50 patients (44%) discontinued anti-diabetes medications (14 sulfonylureas [36%], 7 insulin [23%], 4 sitagliptin [19%]). The mean percentage weight loss achieved at the point of successful discontinuation of medication was 11.2% ± 3.5% (14% for sulphonylureas, 11% for insulin, and 7.1% for sitagliptin). Mean percentage weight loss of 5.6% ± 2.8% (5.1% for sulphonylureas, 4.3% for insulin, and 7.1% for sitagliptin) was required for initial dose reduction. For every 5% weight loss, predicted dose reductions were sulphonylureas, 39%; insulin, 42%; and any anti-diabetic medications, 49%.
  
  
  CONCLUSIONS
  Among overweight or obese patients with type 2 diabetes, intentional weight loss of 7-14% was typically required for full discontinuation of at least one anti-diabetic medication. Discontinuation of insulin was achieved at a mean weight reduction of 11% of initial body weight.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Anita Ashok
authors.initials: AA
authors.lastname: Kumar
authors.forename: Ghanshyam
authors.initials: G
authors.lastname: Palamaner Subash Shantha
authors.forename: Scott
authors.initials: S
authors.lastname: Kahan
authors.forename: Rohit Joshua
authors.initials: RJ
authors.lastname: Samson
authors.forename: Nelson David
authors.initials: ND
authors.lastname: Boddu
authors.forename: Lawrence Jay
authors.initials: LJ
authors.lastname: Cheskin
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D048909:Diabetes Complications / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000628:therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology*; D007328:Insulin / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications; D011719:Pyrazines / Q000494:pharmacology; D012044:Regression Analysis; D012189:Retrospective Studies; D000068900:Sitagliptin Phosphate; D013453:Sulfonylurea Compounds / Q000494:pharmacology; D014230:Triazoles / Q000494:pharmacology; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D011719:Pyrazines; D013453:Sulfonylurea Compounds; D014230:Triazoles; D000068900:Sitagliptin Phosphate