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An RCT analysed the effectiveness of rimonabant in comparison to placebo
in DM 2 overweight patients not appropriately controlled with metformin or sulfonylureas
(87). Together with a diet and exercise intervention, a 20 mg/day dose
of rimonabant was effective to reduce annual weight (-5.3 kg with rimonabant
vs. -1.4 kg with placebo). The interruption of the treatment due to adverse effects
was more frequent with rimonabant due to depressive disorders, nauseas and dizziness.
Recently rimonabant has been withdrawn from the market because of its
adverse effects.
The population groups included in the trials with drugs are very specific, as
patients with severe complications have been excluded. The follow-up period is
very short to assess the long-term safety of the treatments. It must be taken into
account that diabetic patients are polymedicated and frequently suffer from high
comorbidity levels, so the use of a pharmacological treatment cannot be recommended
for the obese diabetic population. This fact has to be taken into consideration
especially when using sibutramine due to its cardiovascular side effects.
The surgical treatment of DM 2 and morbid obesity patients is effective for
weight loss and improvement of glycemic control in specific cases (88).
RCT
1+
SR of RCT,
observational
studies and
case series
1+/2+/3
7.1.3. Composition of fat in the diet
A higher proportion of polyunsaturated /saturated fats has been associated with a
reduction in the mortality risk due to coronary heart disease (89).
The recommendations for the diabetic population are the same as those for
the general population: reduce the intake of saturated fat to