Diabetes medication, lifestyle changes can help treat weight gain induced by antipsychotic drugs

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Public release date: 8-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/jaaj-dma010308.php

Contact: Hua Jin, M.D.

x3904

JAMA and Archives Journals

Diabetes medication and lifestyle changes can help treat weight gain

induced by antipsychotic drugs

Lifestyle intervention and the drug metformin are both effective against

antipsychotic-induced weight gain, and treatment is most effective when

the two therapies are combined, according to a study in the January 9/16

issue of JAMA.

Atypical antipsychotic (AAP) medications have been used increasingly for

the management of patients with a variety of psychotic disorders and

severe behavioral disturbances. But in the past decade, there has been a

growing concern among clinicians and researchers that use of AAP

medications may be related to potentially serious adverse metabolic

effects, including weight gain, hyperlipidemia (high fat levels in the

blood), and glucose intolerance. Metformin is a drug used to treat type

2 diabetes. It inhibits glucose production, is well tolerated, and

prevents continual weight gain while it decreases measures of insulin

resistance. Some studies find that metformin can reduce body weight in

patients with type 2 diabetes and in obese people who do not have

diabetes, according to background information in the article.

Ren-Rong Wu, M.D., of the Mental Health Institute of the Second Xiangya

Hospital, Central South University, China, and colleagues conducted a

randomized controlled trial from October 2004 to December 2006 to test

the efficacy of lifestyle intervention and metformin alone and in

combination for antipsychotic-induced weight gain and abnormalities in

insulin sensitivity. The study included a total of 128 adult patients

with schizophrenia. Participants who gained more than ten percent of

their pre-drug weight were assigned to one of four treatment groups.

The patients continued their antipsychotic medication and were randomly

assigned to 12 weeks of placebo, 750 milligrams per day of metformin

alone, 750 milligrams per day of metformin with lifestyle intervention,

or lifestyle intervention alone. Lifestyle interventions included

psycho-educational, dietary, and exercise programs.

“In this 12-week study, we found statistically significant decreases in

mean weight, BMI [body mass index], waist circumference, insulin, and

IRI [insulin resistance index] among patients in the

lifestyle-plus-metformin, metformin-alone, and lifestyle-plus-placebo

groups, but not among those in the placebo-alone group whose

measurements continued to increase,” the authors write.

Those taking metformin in combination with lifestyle intervention had

average decreases of 1.8 in BMI, 3.6 in IRI, and two centimeters in

waist circumference. Those taking metformin alone showed average

decreases of 1.2 in BMI, 3.5 in IRI, and 1.3 centimeters in waist

circumference. In the lifestyle-plus-placebo group, participants had

average decreases of 0.5 in BMI, and 1.0 in IRI. Participants in the

placebo group continued to show increases in all measures: 1.2 in BMI,

0.4 in IRI, and 2.2 centimeters in waist circumference.

“Lifestyle intervention and metformin alone and in combination

demonstrated efficacy for antipsychotic-induced weight gain. Lifestyle

intervention plus metformin showed the best effect on weight loss,” the

authors conclude. “Metformin alone was more effective in weight loss and

improving insulin sensitivity than lifestyle intervention alone.”

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(JAMA. 2008;299(2):185-193. Available pre-embargo to the media at

www.jamamedia.org)

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