Nancy S.
Age 55
Height 5'4"
Weight 200 lbs
Fasting Insulin
235 pmol/L
HbA1c 9.2%
BP 160/95
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Type 2 Diabetes, BMI 34
Profile and History:
Nancy S., 55, is a type 2 diabetic.
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She is currently taking metformin, 1000 mg bid, and glipizide extended-release, 20 mg/day.
- She was recently started on captopril, 50 mg bid, to reduce her blood pressure, and preserve renal function. Her blood pressure is still elevated in spite of treatment.
- Nancy is chef and owner of a French restaurant.
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Diagnosis and Identification:
Nancy comes to your office for regular monitoring of her glucose levels and her blood pressure.
- She is 5'4", weighs 200 lbs and has a BMI of 34.
- Her fasting insulin level is elevated (235 pmol/L) and her HbA1C is 9.2%.
- Weight loss and increased exercise may reduce her need for glucose-lowering drugs, and may help reduce her blood pressure.
- XENICAL will help her lose weight beyond diet alone and may give her the structure she needs to maintain an appropriate diet plan.
More on identifying patients at risk
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Counseling:
- Nancy offers a list of problems she has with dieting and exercise. She asserts that she doesn't eat "all that much" but that her job requires that she taste food throughout the day. She also says she can't fit exercise into her already hectic schedule.
- You explain the increased risks to Nancy's health if she does not modify her eating habits and activity levels and lose weight. You remind her that because of her profession, she is more likely to know how to make low-fat recipes that taste great, and that walking a few minutes a day will help to make a difference.
- You tell her that XENICAL will help her lose weight and may help her stick to her diet. You ask her to include one XENICAL 120-mg capsule, 3 times a day with each main meal containing fat.
More on counseling your patient
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Treatment:
- Treatment goals for Nancy include weight loss, improved glycemic control to avoid microangiopathy and to reduce cardiovascular risk.
- A strategy including XENICAL and a 1200-calorie per day diet is appropriate. For now, you will not change her diabetes or blood pressure treatments.
- Encouraging Nancy to enroll immediately in the XENICare®
support program and to use the XENICare diary to keep track of
everything that she eats and when she eats ensures greater compliance.
- Finally, walking to work instead of taking cabs would be a realistic activity regimen for Nancy to consider.
More on treatment and management
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Follow-Up:
Nancy returns to your office in 4 weeks with her food diary. She tells you she had no idea that she ate that much while at work. The diary helped her cut back, and, with XENICAL, this has helped her keep her diabetes and blood pressure under control.
More on follow-up care
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Outcomes:
Population with Abnormal (Untreated) Risk Factors at Randomization
Weight Loss with XENICAL Plus Diet: Improved Fasting Insulin and Blood Pressure
- In patients with abnormal baseline values of fasting insulin (>120 pmol/L), weight loss with XENICAL plus diet resulted in a greater decrease in fasting insulin than did placebo (-39 pmol/L vs. -16 pmol/L, respectively) from randomization to 1 year.
- In the population with abnormal blood pressure at baseline (systolic BP >140 mm Hg), the change in systolic blood pressure from randomization to 1 year was greater for patients on XENICAL plus diet (-10.89 mm Hg) than for patients on placebo plus diet (-5.07 mm Hg). Patients with diastolic blood pressure >90 mm Hg on XENICAL plus diet also had greater changes in diastolic blood pressure (-7.9 mm Hg) than those on placebo plus diet did (-5.5 mm Hg).
Population as a Whole
XENICAL Plus Diet: Successful Weight Loss
In clinical trials involving 1064 patients, 69% on XENICAL plus diet lost 3% or more of initial body weight within 3 months, with a mean loss of 13 lbs.18
The mean change in fasting insulin was -6.7 pmol/L for patients on XENICAL plus diet and +5.2 pmol/L for patients on placebo plus diet. The mean change in systolic blood pressure was -1.01 mm Hg for XENICAL plus diet and +0.58 mm Hg for placebo plus diet. The mean change in diastolic blood pressure was -1.19 mm Hg for XENICAL plus diet and +0.46 mm Hg for placebo plus diet.
In clinical trials, the overall mean weight loss from randomization to the end of 1 year in the intent-to-treat population was 13.4 lbs in patients treated with XENICAL plus diet versus 5.8 lbs in placebo-treated patients.
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The long-term effects of orlistat on morbidity and mortality associated with obesity have not been established.
The patient depicted here is fictitious and is intended to illustrate an obesity-related comorbidity for which a treatment regimen including XENICAL plus a reduced-calorie diet is appropriate.
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