School of Medicine, Keele University, Keele; research associate (postdoctoral), School of Health Sciences, University of Manchester, Manchester.
School of Medicine, Keele University, Keele; clinical lecturer, Centre for Public Health, Queen's University Belfast, Belfast.
Br J Gen Pract. 2024 Oct 31;74(748):758-766. doi: 10.3399/BJGP.2023.0684. Print 2024 Nov.
Orlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM).
To explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes.
Cohort study using anonymised health records from a UK database of general practice.
The UK Clinical Practice Research Datalink (CPRD) Aurum database was searched to compile a cohort of patients aged ≥18 years, first diagnosed with T2DM or prediabetes in 2016 or 2017. Once the data had been collated, multivariable logistic regression models were used to determine associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat's associations with weight loss in those who had not been prescribed second-line antidiabetic medications.
Out of 100 552 patients with incident T2DM or prediabetes, 655 (0.8%) patients with T2DM and 128 (0.7%) patients with prediabetes were prescribed orlistat. Younger people, females, those in areas of deprivation, current smokers, those coprescribed metformin, and those recorded as having hypertension were statistically significantly more likely to be prescribed orlistat; higher baseline glycated haemoglobin levels were associated with early stopping. In comparison with patients not on orlistat, those who continued using it for ≥12 weeks were more likely to lose ≥5% weight (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI] = 1.07 to 2.67) but those who stopped orlistat early were less likely to lose ≥5% weight (AOR 0.56, 95% CI = 0.29 to 1.09).
Orlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss.
奥利司他被推荐作为饮食和运动的辅助手段，用于治疗 2 型糖尿病（T2DM）患者的体重减轻。
探讨患者特征与奥利司他处方之间的关联，并确定奥利司他与 T2DM 和糖尿病前期患者体重减轻之间的关联。
使用英国一般实践数据库的匿名健康记录进行队列研究。
英国临床实践研究数据链接（CPRD）Aurum 数据库被搜索，以汇编一组年龄≥18 岁的患者，这些患者在 2016 年或 2017 年首次被诊断为 T2DM 或糖尿病前期。一旦数据被整理，多变量逻辑回归模型被用于确定开始服用奥利司他和提前停药（<12 周的处方）的关联，以及在未服用二线抗糖尿病药物的患者中，奥利司他与体重减轻的关联。
在 100552 例新诊断为 T2DM 或糖尿病前期的患者中，655 例（0.8%）T2DM 患者和 128 例（0.7%）糖尿病前期患者被处方奥利司他。年轻人、女性、处于贫困地区的人、当前吸烟者、同时服用二甲双胍的人以及记录为患有高血压的人被处方奥利司他的可能性显著增加；较高的基线糖化血红蛋白水平与早期停药有关。与未服用奥利司他的患者相比，继续服用奥利司他≥12 周的患者更有可能减轻≥5%的体重（调整后的优势比[OR]1.69，95%置信区间[CI]为 1.07 至 2.67），但提前停药的患者减轻≥5%体重的可能性较低（OR 0.56，95%CI=0.29 至 1.09）。
当奥利司他服用至少 12 周时，与 T2DM 和糖尿病前期患者的体重减轻显著相关；然而，它的处方频率较低，通常服用时间<12 周。奥利司他可能是 T2DM 和糖尿病前期患者生活方式改变的有用辅助手段，但由于持续使用的障碍，它可能并不适合所有人来管理体重减轻。
