Angela P.
Age 45
Height 5'6"
Weight 190 lbs
HbA1c 6.2%
FPG
1 hour 180 mg/dL
2 hours 170 mg/dL
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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. You ordered a glucose tolerance test. When she arrives for her follow-up appointment, you tell her that her blood work revealed that she has impaired glucose tolerance (FPG 108, 1 hour 180 mg/dL, 2 hours 170 mg/dL).
- She is 5'6", weighs 190 and has a BMI of 31.
- Her HbA1C is 6.2%.
- 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 abnormal GTT. 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.
- You explain to her the value of XENICAL in the XENDOS study in preventing patients like her from progressing to type 2 diabetes. She seems interested in taking XENICAL.
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.
- An 1800-calorie per day diet containing no more than 30% of calories from fat, and XENICAL seem appropriate to help her meet her weight-loss goals.
- XENICAL 120 mg up to 3 times a day, with meals containing fat.
More on treatment and management
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Follow-Up:
When Angela returns to
your office in 4 weeks, she reports that she has lost 6 lbs but, more importantly,
that she feels she has more energy.
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Outcomes:
In the four year XENDOS study, the effects of orlistat on weight loss and in delaying the onset of type 2 diabetes was compared to placebo in 3304 obese patients who had either normal or impaired glucose tolerance at baseline. At the end of the 1st year of treatment, 73% of the XENICAL treated patients and 45% of the placebo treated patients had a >5% weight loss. After four years, the relative risk reduction for developing type 2 diabetes in patients with impared glucose tolerance was 42% less in the diet plus XENICAL group compared to the diet plus placebo group (p<0.01). In addition, greater reductions in total cholesterol, LDL-cholesterol, LDL/HDL ratio, fasting insulin systolic and diastolic blood pressure and waist circumference were observed in diet plus XENICAL treated patients compared to diet plus placebo treated patients.
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The long-term effects of XENICAL (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. Individual results may vary.
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