| Abstract | A 57-year-old Caucasian woman with Type 2 diabetes treated for seven years with diet and oral combination hypoglycaemic therapy was referred because of the progressive deterioration of glycaemic control. She was obese (77 kg, BMI = 39.9), hypertensive, hypercholesterolaemic with marked osmotic symptoms (HbA(1c) 12.2%), therefore she was started on insulin (Human Mixtard 30 b.d.) with metformin therapy. Dietary counselling, recommendations to increase physical activity, and supervised self-injection technique with titration of her insulin were also provided. She was routinely followed-up to assess her progress. Two years later, her glycaemic control remained suboptimal. Average HbA(1c) was 10.4% despite an increasingly high dose of insulin (94 units/day) although it improved when metformin was increased to 1 g t.d.s. (HbA(1c) = 9.3%). Her BMI progressively rose from 39.9 to 42.1 (77 to 82.5 kg) despite dietary advice. A trial of orlistat (three months) was commenced, after intensive dietary counselling, that reduced her body weight by 1.5 kg (2% reduction, BMI 41.3). However, her HbA(1c) improved by 0.5% (from 9.3 to 8.8%). Six months after orlistat was stopped her HbA(1c) rose to 10.5% and weight increased to 81.8 kg (BMI 41.8). Despite the orlistat treatment broaching NICE guidelines should it have been continued? |
| Authors | S González, E S Kilpatrick, S L Atkin
(Affiliation: Department of Medicine, University of Hull, Hull, UK. ucm_sg at hotmail.com)
|
| Journal | Diabetic medicine : a journal of the British Diabetic Association
(Diabet Med)
Vol. 22
Issue 3
Pg. 344-5
(Mar 2005)
ISSN: 0742-3071 England |
| PMID | 15717886
(Publication Type: Case Reports, Journal Article)
|
| Chemical References |
- Hemoglobin A, Glycosylated
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
- Hypoglycemic Agents
- Lactones
- Insulin
- Metformin
- orlistat
|
| Topics |
- Diabetes Mellitus, Type 2
(blood, diet therapy, drug therapy)
- Female
- Guideline Adherence
- Hemoglobin A, Glycosylated
(analysis)
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors
(therapeutic use)
- Hypoglycemic Agents
(therapeutic use)
- Insulin
(administration & dosage)
- Lactones
(therapeutic use)
- Metformin
(therapeutic use)
- Middle Aged
- Obesity
(blood, diet therapy, drug therapy)
- Practice Guidelines as Topic
- Weight Loss
|
