orlistat and Prediabetic-State

To review the efficacy and safety of liraglutide, marketed as Saxenda, a glucagon-like peptide-1 analog for obesity management.. A MEDLINE search (1970 to March 2015) was conducted for English-language articles using the terms glucagon-like peptide 1, liraglutide, and obesity.. Published articles pertinent to the efficacy and safety of liraglutide for short- and long-term obesity management among overweight or obese patients and special populations were reviewed and summarized.. Based on randomized placebo-controlled and active-comparator studies, liraglutide can increase weight loss among overweight and obese patients in a dose-dependent manner with once-daily doses of 1.2 to 3.0 mg. It has been shown that a higher proportion of patients experienced 5% and 10% weight loss from baseline compared with placebo and orlistat. Data support the potential benefit of liraglutide among overweight and obese patients with prediabetes, as well as women with polycystic ovary syndrome (PCOS) with an inadequate response to metformin. Larger and more robust studies are needed to determine the clinical significance of liraglutide among other agents for obesity in diverse populations.. Liraglutide is an adjunct to lifestyle modifications to improve success rates among overweight or obese individuals without diabetes. It may have a potential role in special populations, such as in those with prediabetes and women with PCOS. Based on its clinical evidence, liraglutide can result in more weight loss from baseline compared with orlistat and placebo. Adverse events associated with liraglutide are primarily gastrointestinal and usually dose dependent.

Topics: Anti-Obesity Agents; Female; Humans; Injections, Subcutaneous; Lactones; Life Style; Liraglutide; Obesity; Orlistat; Polycystic Ovary Syndrome; Prediabetic State; Randomized Controlled Trials as Topic

Intervention in weight management should begin before the onset of the metabolic syndrome. Therapeutic lifestyle changes (e.g., diet and physical activity) comprise the cornerstone of care for overweight and obese patients. Behavior modification approaches are useful in facilitating adherence to specific dietary regimens. Pharmacotherapy is an option for patients with a BMI >30 kg/m(2) or for those with a BMI of 27 to 30 kg/m(2) and two or more risk factors, who have failed on diet and exercise alone. To date, the U.S. Food and Drug Administration has approved three weight loss agents: sibutramine, orlistat, and phentermine.

Topics: Caloric Restriction; Cardiovascular Diseases; Cyclobutanes; Diabetes Mellitus; Diet; Diet, Fat-Restricted; Diet, Mediterranean; Exercise; Feeding Behavior; Food, Formulated; Humans; Lactones; Metabolic Syndrome; Obesity; Orlistat; Phentermine; Prediabetic State; Risk Reduction Behavior; Weight Loss

The frequency of obesity has risen dramatically in recent years but only few safe and effective drugs are currently available. We assessed the effect of liraglutide on bodyweight and tolerability in obese individuals without type 2 diabetes.. We did a double-blind, placebo-controlled 20-week trial, with open-label orlistat comparator in 19 sites in Europe. 564 individuals (18-65 years of age, body-mass index 30-40 kg/m2) were randomly assigned, with a telephone or web-based system, to one of four liraglutide doses (1.2 mg, 1.8 mg, 2.4 mg, or 3.0 mg, n=90-95) or to placebo (n=98) administered once a day subcutaneously, or orlistat (120 mg, n=95) three times a day orally. All individuals had a 500 kcal per day energy-deficit diet and increased their physical activity throughout the trial, including the 2-week run-in. Weight change analysed by intention to treat was the primary endpoint. An 84-week open-label extension followed. This study is registered with ClinicalTrials.gov, number NCT00422058.. Participants on liraglutide lost significantly more weight than did those on placebo (p=0.003 for liraglutide 1.2 mg and p<0.0001 for liraglutide 1.8-3.0 mg) and orlistat (p=0.003 for liraglutide 2.4 mg and p<0.0001 for liraglutide 3.0 mg). Mean weight loss with liraglutide 1.2-3.0 mg was 4.8 kg, 5.5 kg, 6.3 kg, and 7.2 kg compared with 2.8 kg with placebo and 4.1 kg with orlistat, and was 2.1 kg (95% CI 0.6-3.6) to 4.4 kg (2.9-6.0) greater than that with placebo. More individuals (76%, n=70) lost more than 5% weight with liraglutide 3.0 mg that with placebo (30%, n=29) or orlistat (44%, n=42). Liraglutide reduced blood pressure at all doses, and reduced the prevalence of prediabetes (84-96% reduction) with 1.8-3.0 mg per day. Nausea and vomiting occurred more often in individuals on liraglutide than in those on placebo, but adverse events were mainly transient and rarely led to discontinuation of treatment.. Liraglutide treatment over 20 weeks is well tolerated, induces weight loss, improves certain obesity-related risk factors, and reduces prediabetes.. Novo Nordisk A/S, Bagsvaerd, Denmark.

Topics: Analysis of Variance; Anti-Obesity Agents; Body Mass Index; Dose-Response Relationship, Drug; Double-Blind Method; Europe; Female; Glucagon-Like Peptide 1; Humans; Injections, Subcutaneous; Lactones; Liraglutide; Logistic Models; Male; Obesity; Orlistat; Prediabetic State; Safety; Treatment Outcome; Waist Circumference; Weight Loss

Overt type 2 diabetes is usually preceded by a condition known as prediabetes, which is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Both IFG and IGT exhibit elevated glucose levels that are not sufficient to be classified as diabetes but that represent the development of insulin resistance. Achieving glycemic control in patients with prediabetes through lifestyle and pharmacologic interventions can effectively prevent or delay the development of diabetes and its associated complications. The first step, however, is to identify patients at risk. Although patients can be identified with an oral glucose tolerance test (OGTT) or a fasting plasma glucose (FPG) screening, a normal FPG does not preclude an elevated OGTT and, therefore, the presence of prediabetes. For patients who progress to type 2 diabetes, intensive therapy aimed at reducing and maintaining glycosylated hemoglobin (A1C) levels < 7% has been shown to reduce the risk of complications. An A1C level > or = 7% should signal the need to initiate or change therapy to achieve glycemic goals.

Topics: Acarbose; Anti-Obesity Agents; Clinical Trials as Topic; Diabetes Complications; Diabetes Mellitus, Type 2; Disease Progression; Humans; Hypoglycemic Agents; Lactones; Life Style; Metformin; Orlistat; Prediabetic State; Thiazolidinediones