Weight gain during insulin therapy in patients with type 2 diabetes mellitus

In patients with diabetes, the benefits of tight glycemic control are unequivocal-delayed onset and progression of complications such as retinopathy, nephropathy, and neuropathy. However, intensive therapy with insulin and some oral antidiabetic agents come at the price of weight gain, a condition that can prevent attainment of tight glycemic goals and probably limits success of treatment. Insulin-related weight gain has been attributed to anabolic effects of insulin, appetite increases, and reduction of glycosuria. Use of metformin in combination with insulin is commonly recommended as a way to limit weight gain in patients with type 2 diabetes, and other new oral therapies and insulin analogs may also provide weight-control advantages. Lifestyle interventions (patient education about diet and exercise) promote weight loss in the short-term, but have not sustained weight control over long-term intervals. For lasting weight control, such interventions may need to continue throughout the course of treatment. Likewise, weight-loss agents, such as sibutramine and orlistat promote short-term weight loss, but no follow-up studies have yet demonstrated that this loss can be maintained for 5 years or longer. Bariatric surgery is the only treatment recognized to have lasting effects on weight control, but its use is limited at present to those who are morbidly obese. (C) 2004 Elsevier Ireland Ltd. All rights reserved.