Comparative evaluation of the efficiency of monotherapy with metformin and orlistat in patients with type 2 diabetes

The purpose of the study was to evaluate the efficacy of orlistat versus metformin on the time course of changes in body weight (BW), lipid metabolism, blood pressure (BP), glycated hemoglobin (HbA_1c, the kinetic parameters of'the oral glucose tolerance test (OGTT), and insulinemia in patients with type 2 diabetes (T2D). Two groups of patients with mild T2D with overweight or obesity were selected. Group 1 comprised 25 patients aged 53.16±8.92 years, who had a 2.50±3.06-year history. In this group, all the patients were given metformin in the daily starting dose of 500 mg. Group 2 patients (n = 26) aged 53.07±6.70 years, who had a 2.60±2.91-year history, took orlistat (xenical) (F. Hoffman-La Roche, Switzerland) in a dose of 120 mg thrice daily with meals. In addition, to exclude the impact of the time course of changes in body mass index (BMI) on carbohydrate and fat metabolic parameters, the twin method was used to select from each group 12 patients with similar ВW changes, matched by age, gender, the history of T2D, and the time course of changes in all anthropometric indices. The study revealed that orlistat and metformin exerted a comparable beneficial effect on carbohydrate and lipid metabolisms, BP in overweight or obese patients with T2D. Orlistat produced a significantly more pronounced effect on BW than did metformin. Unlike, orlistat, metformin significantly lowered fasting blood glucose levels due to the known inhibitory effect of hepatic glucose hyperproduction in overweight or obese patients with T2D. By excluding the Impact of BW loss on carbohydrate metabolism in overweight or obese patients with T2D, orlistat had a more marked sugar-lowering effect evaluated by the level of HbA_1c This may be accounted for by the fact that with the specific suppression of fat absorption, orlistat may diminish intestinal carbohydrate absorption.

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