Angela P.
Age 45
Height 5'6"
Weight 190 lbs
HbA1c 6.8%
FPG 120 mg/dL
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Previous Patient Profile
Impaired Glucose Tolerance, BMI 31
Profile and History:
Angela P. is 45 years old and African American, and has had asthma almost all of her life.
- Currently, she is using beclomethasone MDI prophylactically and albuterol MDI p.r.n.
- She tries to take care of herself by exercising regularly and taking her medication faithfully.
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Diagnosis and Identification:
Angela saw you 2 weeks ago complaining of fatigue and weight gain. When she arrives for her follow-up appointment, you tell her that her blood work revealed that she has impaired fasting glucose. (FPG 120 mg/dL)
- She is 5'6", weighs 190 and has a BMI of 31.
- Her HbA1C is 6.8%.
- As an African American, Angela has a higher risk of developing type 2 diabetes.6 Losing weight would substantially reduce this risk.
More on identifying patients at risk
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Counseling:
- Angela seems somewhat surprised to hear about her high fasting glucose. She asks many questions and you explain to her the risks, especially the potential to progress to diabetes, and the effect weight has on this progression, as well as the effect extra weight can have on her asthma.
- Angela tells you that she's always been large (it runs in her family) and that she really doesn't want to become "skinny."
- You suggest that she may be exaggerating how much weight she actually needs to lose. A 10-lb to 20-lb loss (5% to 10% of body weight) is a reasonable goal. As you both talk, it appears that Angela's weight-loss expectations have become more reasonable and that she seems more positive about setting a realistic goal.
More on counseling your patient
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Treatment:
- Treatment goals include a weight-loss plan that will help reduce the risks of developing type 2 diabetes and cardiovascular disease.
- A 1600-calorie per day diet and XENICAL seem appropriate to help her meet her weight-loss goals.
- To help change her diet, you refer her to the XENICare®
program.
More on treatment and management
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Follow-Up:
When Angela returns to
your office in 3 weeks, she reports that she has lost 2 lbs but, more importantly,
that she feels she has more energy. She was able to find help through the
XENICare program, which is making it easier to stick to the plan
you've created together.
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
- 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.
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.
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.
Previous Patient Profile
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