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Metformin and Carbohydrate-Modified Diet May Help Sustain Weight Loss

The combined regimen of metformin and a carbohydrate-modified diet promotes long-term weight stabilisation in obese, middle-aged, nondiabetic women with documented insulin abnormalities, say American researchers.

The majority of patients who successfully lose weight in traditional dietary programs regain the weight within 2 to 4 years, and few treatment strategies for sustained weight reduction exist that are effective, safe, and acceptable.

In a previous study, women with Syndrome W, an early variant of the Metabolic Syndrome, achieved significant weight loss with metformin and a carbohydreate-modified, hypocaloric, low-glycaemic-index diet.

To assess the long-term efficacy this regimen, Harriette R Mogul, MD, MPH, and colleagues of New York Medical College, Valhalla, United States, conducted a retrospective analysis of 21 study participants who returned for medication renewal and annual surveillance visits.

All patients included in the analysis had achieved a 1-year weight loss of more than 10% or body mass index (BMI) normalisation. Baseline characteristics included an average age of 55.2 years, BMI of 34.2 kg/m², and weight of 196.9 lbs.

The researchers observed weight maintenance at the final (2 to 4 years) follow-up visit in 90.5% of the women, with the mean weight at final follow-up highly correlated with mean weight at 1-year protocol completion.

Furthermore, a significant and robust decline in fasting insulin (-27.5% -43.8%, P < .002) was observed at all follow-up visits. Metformin was well tolerated, without reported side effects or electrolyte imbalance.

Although researchers acknowledge clear methodologic limitation, they hope that the study findings will encourage clinicians to contemplate the potential viability of defining and treating insulin abnormalities in euglycemic women with midlife weight gain who fail to respond to other obesity interventions.

"We believe this effective novel obesity treatment, which is easily implemented in a clinical setting, could have important implications for women with Syndrome W, and quite possibly for other subpopulations of obese nondiabetic Americans with progressive weight gain and documented hyperinsulinemia," they conclude.


Heart Dis 2003 Nov-Dec;5:6:384-92. "Long-term (2-4 year) weight reduction with metformin plus carbohydrate-modified diet in euglycemic, hyperinsulinemic, midlife women (syndrome w)"

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