1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Cannabinoid-Receptor–Blocker Appears to Reduce Weight and Lower HbA_1c in Diabetics

With rimonabant, patients reduced weight and cardiovascular risk factors.

Endogenous cannabinoids, interacting with cannabinoid type 1 (CB₁) receptors in fat, liver, skeletal muscle, and other tissues, stimulate appetite and adversely affect glucose and lipid metabolism. Rimonabant, a selective CB₁-receptor–blocker awaiting FDA approval, lowers weight and improves some cardiovascular risk factors in overweight nondiabetic patients. To determine whether these results would extend to patients with type 2 diabetes, industry-supported researchers randomized 1047 overweight patients whose diabetes was not fully controlled with metformin or sulfonylurea monotherapy to receive daily rimonabant (5 mg or 20 mg) or placebo. All patients were advised to eat a low-calorie diet and to exercise.

At 1 year, patients receiving high-dose rimonabant had lost a mean of 5.3 kg, compared with 2.3 kg in the low-dose rimonabant group and 1.4 kg in the placebo group. HbA_1c levels fell by 0.6% in the high-dose rimonabant group and rose by 0.1% in the placebo group (all significant differences). The reduction in HbA_1c levels with high-dose rimonabant was about twice that attributable to weight loss alone. Compared with patients who took placebo, those who took high-dose rimonabant achieved significant improvements in waist circumference, fasting glucose, HDL cholesterol levels, and triglyceride levels, but not in total or LDL cholesterol levels. Adverse effects in the rimonabant groups (principally nausea, dizziness, depression, and anxiety) were generally mild-to-moderate and transient.

Comment: Rimonabant appears to offer a promising new approach to obesity, type 2 diabetes, and prevention of cardiovascular disease. Long-term efficacy and safety data are needed.

— Bruce Soloway, MD

Published in Journal Watch General Medicine December 19, 2006

Citation(s):

Scheen AJ et al. Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: A randomised controlled study. Lancet 2006 Nov 11; 368:1660-72.

• Medline abstract (Free)