• For patients with impaired glucose tolerance (IGT),
lifestyle changes decrease the risk of developing
diabetes; however lifestyle may be hard to
maintain. Drugs such as metformin and
acarbose may also be useful for IGT/weight loss.
{Rosiglitazone ↓ progression to diabetes, but ↑HF, edema & wt.}
• Metformin is useful for obese patients with Type
2 diabetes (providing no contraindication) for its
beneficial outcomes and weight loss potential.
• Drugs known to decrease morbidity & mortality in
patients with CV risk should be considered. (e.g.
ASA, antihypertensives and statins).
• Drugs that should not be used for weight loss:
o thyroid hormone: may cause bone loss & arrhythmias
o amphetamines (eg. Adderal)
• New Drug: Rimonibant (Not yet in Canada)
o A cannabinoid (CB1) receptor blocker with favourable
changes in weight (-6kg/1yr 20mg daily) and cardiometabolic
risk factors (↓waist circumference ↓TG; ↑HDL). Side effects
(e.g. nausea, anxiety, depression), a high drop-out rate >45%
and lack of clinical outcome trials warrant caution.
