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Diet Drug Cuts Blood Sugar, Trims Waistline in Type 2 Diabetics, Study Finds

Posted on: Sunday, 12 June 2005, 21:00 CDT

TORONTO (CP) - A drug that curbs appetite has been found to reduce a host of factors that contribute to type 2 diabetes - including elevated blood sugar levels, a study has shown.

The drug, rimonabant, was found to significantly lower levels of elevated blood sugar, insulin and triglycerides (a type of fat in the blood) as well as trimming waist circumference in patients with type 2 diabetes, the international study found. At the same time, it appeared to boost levels of HDL, the good cholesterol.

Rimonabant works by blocking cell receptors in the region of the brain responsible for regulating hunger and satiety. Research has shown that these CB1 receptors are linked to excess hunger - what's known as the "stone munchies" - in people who use cannabis.

Receptors are like locks on the cell surface that accept specific keys, in this case a certain enzyme. For CB1 receptors, the enzyme is known as an endocannabinoid.

But rimonabant also jams CB1 receptors present in large fat cells in people with "big bellies," said Dr. Jean-Pierre Despres, director of research at the Quebec Heart Institute in Quebec City, who was involved in the study.

Abdominal fat, more than overall excess weight, has been found to play a key role in the development of cardiovascular disease and diabetes, Despres said.

"If you have an elevated waist and elevated triglycerides, you are a time bomb for diabetes and heart disease. It is as simple as that."

Results of the one-year RIO-Diabetes study, which involved 1,045 people with type 2 diabetes (including 140 from across Canada), were presented Sunday at the American Diabetes Association meeting in San Diego, Calif.

Researchers around the world, led by Andre Scheen of the University of Liege in Belgium, compared outcomes between patients on a daily dose of rimonabant and those on placebo, or a dummy pill.

They found that 52.7 per cent of patients on the drug achieved a blood sugar measure below the target treatment goal set by the American Diabetes Association, compared to 26.8 per cent in the placebo group.

"What is noteworthy about the findings of the RIO-Diabetes trial is that even in a patient population with an average (blood sugar) level at a point where further control is difficult to achieve, rimonabant was still able to achieve a clinically significant reduction," Scheen, an expert in treating diabetes, said in written remarks before presenting his study.

Weight loss was calculated to be responsible for less than half of the reduction in blood sugar among those given the drug.

Still, patients taking rimonabant lost more weight on average than those on placebo, the study showed.

The average weight loss among those given the drug was 5.3 kilograms (11.7 pounds) versus 1.4 kilograms (three pounds) for those who didn't get the drug.

As well, participants taking the drug reduced their waist circumference by 5.2 centimetres (two inches), compared with 1.9 centimetres (0.7 inches) for the non-drug group.

"The weight loss reported for rimonabant in patients with diabetes may be an important finding," Dr. Michael Jensen, a professor of medicine at the Mayo Clinic in Rochester, Minn., said in a release prior to the study's presentation Sunday.

"Glycemic control with current therapies is often associated with weight gain," Jensen said. "This weight gain can diminish the benefits of treatment and lessen the overall improvement in cardiometabolic risk."

The study also found that the rise of HDL cholesterol in those on the drug was more than twice that of patients on placebo; the difference in triglyceride reduction was more than 16 per cent between the two groups.

Side-effects, which were mostly mild and did not last long, included nausea, dizziness and diarrhea, the researchers found.

Complications of type 2 diabetes include vision loss, kidney failure and circulatory damage that can lead to limb amputation.

About 75 per cent of type 2 diabetics die from heart disease, said Despres, noting that fat cells in people with abdominal obesity secrete a substance suspected to cause inflammation linked to cardiovascular disease, but are low in another substance, called adiponectin, that may protect against heart disease and diabetes.

"The problem with type 2 diabetic patients and with people with big bellies, they have very low adiponectin levels . . . Large abdominal fat cells don't produce enough adiponectin," Despres said from San Diego, where he was to present results from his study showing rimonabant boosts its production, and thereby elevates the good cholesterol, HDL.

"We have an epidemic of type 2 diabetes in Canada; it's almost 10 per cent of the Canadian population," he said. "If we think we have a problem right now, there's a whole wave, the next generation of young Canadian adults, that are going to begin their young adult life being overweight and obese."

That's because most Canadians, like other western populations, continue to eat high-fat foods, lead sedentary, high-stress lives and don't get enough exercise, he said.

But Despres cautioned that rimonabant is not intended as a quick fix for those who want to pop a pill to shed a few pounds, saying it should be prescribed only for those at risk of diabetes and heart disease who have not responded to other means - such as diet and exercise - to improve their health.

"It has to be said loud and clear, this won't be a weight-loss drug, it won't be a miracle drug. This is really, really the wrong approach."

Source: Canadian Press

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