Anti Obesity Drug : Rimonabant (Acomplia) Shown Effective also for Improving Blood Sugar Levels
There are two types of diabetes. Type 1 occurs when the body doesn't produce any insulin. People with type 2 diabetes either don't produce enough insulin or their cells ignore the insulin. Nearly 95% of people with diabetes have type 2.
You are at risk for getting IFG or diabetes if any of the following are true:
- You are overweight or obese.
- You have a parent, brother or sister who has diabetes.
- You were diagnosed with diabetes during pregnancy or had a baby who weighed more than 9 pounds at birth.
- You belong to any of the following ethnic groups: African American, Native American, Latin American or Asian/Pacific Islander.
- You have high blood pressure (above 140/90 mm Hg).
- Your high-density lipoprotein (HDL) cholesterol level (“good” cholesterol) is less than 40 mg per dL (for men) or less than 50 mg per dl (for women), or your triglyceride level is higher than 250 mg per dL.
Diabetes medicines are not as effective as diet and physical activity. However, your doctor might prescribe a diabetes medicine if you are at high risk for diabetes and have other medical problems, such as obesity, a high triglyceride level, a low HDL cholesterol level or high blood pressure.
A new drug to help people lose weight, rimonabant (brand named Acomplia), also helps people with type 2 diabetes shed pounds while improving their blood sugar levels, researchers say.
Rimonabant is being tested and is approved in Europe. However, it has not yet been approved for use in the United States. This finding suggests that rimonabant could be used as a new approach for treating diabetes where other drugs have failed.
"This is an interesting new class of drugs that probably offers something new and different to people with diabetes," said Dr. Larry Deeb, president of medicine and science at the American Diabetes Association. He was not involved in the research.
In the study, Andre Scheen, from the University of Liege, Belgium, and colleagues looked at the effects of rimonabant in over 1,000 patients with poorly controlled type 2 diabetes. All the patients were obese or overweight and had failed treatment with other drugs.
The patients were given a low-calorie diet plan and advised to be more physically active. They were also given rimonabant at a dose of either 5 milligrams or 20 milligrams per day, or a placebo.
After a year, Scheen's team found that patients taking rimonabant lost significantly more weight than those taking the placebo. Patients on placebo lost an average of 1.4 kilograms, compared with 2.3 kilograms for those given 5 milligrams per day and 5.3 kilograms in patients taking 20 milligrams per day. (For conversion, one kilogram is equal to just over 2 pounds.)
In addition, patients taking rimonabant had greater improvement in waist size, blood sugar control, cholesterol, and better appetite control, compared with patients receiving placebo, the researchers report.
"These findings support the use of 20 mg per day of rimonabant, in addition to diet and exercise, as a new approach to reduce body weight and improve blood glucose control as well as several other cardiovascular risk factors in overweight or obese patients with type 2 diabetes that was inadequately controlled by standard treatment," the researchers concluded.
But other experts noted that the drug does have one potential drawback: its association with an increased risk of depression.
In an accompanying journal editorial, Stephen J. Cleland and Naveed Sattar from Stobhill Hospital, Glasgow, and the BHF Glasgow Cardiovascular Research Centre at the University of Glasgow noted that as many as 50 percent of obese patients suffer from depression.
"In this context, the suggestion that rimonabant increases depression and anxiety is concerning," they wrote. Studies are needed to assess the effect of the drug on depression among obese diabetic patients, they said.
Julissa Viana, a spokeswoman for Sanofi-Aventis, said that the issue of depression is one the company is looking at.
There were people in the trial with mild to moderate depression who did not suffer any adverse consequences, according to Viana. "All recovered with medication or counseling," she said.
And, Viana said, depression is not a common side effect of rimonabant. "It falls beneath the 5 percent threshold for a major side effect," she said. "The indication is clear about who it should be used for," she added.
Right now, there is a warning in Europe that rimonabant should not be given to patients who have serious uncontrolled psychiatric illness, such as a major depression. Treatment for depression should be started first, Viana said. "We don't have data about the use of rimonabant and antidepressant medications," she added.
The ADA's Deeb believes rimonabant may offer new options for diabetics and help tailor treatment to individual needs. "What this does is allow the physician to think about the individual approach to management," he said. "Having choices like this is helpful."
However, Deeb said that he's also concerned about the depression issue with the drug. "I would not give this drug to a patient who was depressed," he said.