Barbara K.
Age 51
Height 5'5"
Weight 188 lbs
BP 160/90
Fasting Insulin
191 pmol/L
HbA1c 8.1%
Lipid Profile:
HDL 30 mg/dL
LDL 178 mg/dL
LDL/HDL ratio 5.9
TC 270 mg/dL
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Multiple Risks: Type 2 Diabetes, Dyslipidemia,
High Blood Pressure, BMI 31
Profile and History:
Barbara K., 51, is a new patient. She has type 2 diabetes, dyslipidemia and high blood pressure.
- A review of her current medications indicates that she is taking metformin and glipizide for diabetes.
- She's also taking lisinopril for her recently diagnosed high blood pressure and Simvastatin for her elevated cholesterol.
- She's a full-time student who also works a part-time job.
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Diagnosis and Identification:
- Barbara is 5'5", weighs 188 lbs and has a BMI of 31.
- Her HDL is 30 mg/dL, her LDL is 178 mg/dL, her LDL/HDL ratio is 5.9, her TC is 270 mg/dL and her triglyceride level is 310 mg/dL.
- Her blood pressure is 160/90.
- Her fasting insulin level is high (191 pmol/L) and her HbA1C
is 8.1%.
- Given her complex medical issues, Barbara needs to lose weight to avoid potential cardiovascular complications.
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Counseling:
When you broach the subject of weight loss with Barbara, she seems to accept this recommendation. Barbara does express concern, however, about her ability to stick to a diet that doesn't accommodate her schedule.
- She's heard about XENICAL and asks you to discuss with her the possibility of using this drug.
- XENICAL will help her lose weight if she uses it as part of a complete diet program. Aside from counting calories, she'll have to make sure what she eats has no more than 30% fat.
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Treatment:
- Your treatment goals include weight loss, improved glycemic control to minimize risk of microvascular disease, improved lipid profile, optimal blood pressure and reduced cardiovascular risk.
- A regimen including XENICAL and a 1200-calorie per day diet is advisable.
- Barbara should also be encouraged to maintain a diet diary and to schedule regular follow-up visits.
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Follow-Up:
Barbara calls your office 2 weeks after her visit. She's found that she can really take the time to make a low-calorie, low-fat meal when she comes home. She's lost 2½ lbs, and feels sure that this will continue.
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Outcomes:
Population with Abnormal (Untreated) Risk Factors at Randomization
Weight Loss with XENICAL Plus Diet: Improved Lipid Levels, Fasting Insulin and Blood Pressure
- The changes from randomization following 1-year treatment in the population with abnormal lipid levels (LDL >130 mg/dL, LDL/HDL >3.5, HDL <35 mg/dL) were greater for patients on XENICAL plus diet compared to patients on placebo plus diet with respect to LDL cholesterol (-7.83% vs. +1.14%) and the LDL/HDL ratio (-0.64 vs. 0.46). HDL cholesterol increased in the placebo group by 20.1% and in the XENICAL group by 18.8%.
- 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).
Type 2 Diabetes and treatment with XENICAL
- In a study of patients with type 2 diabetes stabilized on sulfonylureas, 30% of the patients treated with XENICAL achieved at least a 5% or greater reduction in body weight after one year of treatment compared to 13% of the placebo treated patients. The XENICAL plus sulfonylurea treated patients also achieved significant reductions in sulfonylurea usage and dose reduction as well as significant reductions in HbA1c and fasting glucose compared to the placebo plus sulfonylurea treatment group. In addition treatment with XENICAL plus sulfonylurea was associated with significant reductions in total cholesterol, LDL-cholesterol, LDL/HDL ratio and triglycerides compared to placebo plus sulfonylurea treatment group.
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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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