Primary care prescribing of orlistat medication for weight management in adults with type 2 diabetes: an epidemiological study

Ghosal, Shraboni

Abstract

Introduction
The incidence of type 2 Diabetes mellitus (T2DM) is increasing and is a major public health burden. Obesity is one of the main modifiable risk factors for T2DM. However no UK studies have assessed the relationship of orlistat, a medication for treating obesity, with weight loss in T2DM and prediabetes.

Aims
This PhD study aimed to assess current UK primary care orlistat prescribing in overweight/obese adults with T2DM and prediabetes.

Methods
A Systematic review determined in T2DM patients the efficacy of orlistat, incorporating a meta-analysis. With UK primary care electronic health record (EHR) data, the extent orlistat is used in primary care and its association with reduced weight were assessed.

Results
The Systematic review showed that reductions in weight, blood glucose levels and blood pressure are achievable with orlistat in individuals with T2DM/prediabetes and obesity. In the main study, there were 100,552 adults with T2DM or prediabetes (2016-2017). The incidence rate of orlistat in T2DM patients was 7.9/1000 persons [95% confidence interval (CI): 7.3, 8.6]. The results confirmed that orlistat is being prescribed to those with a BMI of ≥28kg/m2.
Individuals with T2DM and prediabetes who continued orlistat for more than 12 weeks were more likely to lose ≥5% weight in 1 year whilst those who stopped orlistat early were less likely (OR: 1.69, 95% CI: 1.07, 2.67 versus no orlistat use and OR: 0.56, 95% CI: 0.29, 1.09 respectively). HbA1c also reduced in 1 year and in those who continued orlistat, systolic BP reduced significantly.

Conclusion
This study showed that UK primary care orlistat prescribing guidelines are being followed. Orlistat is associated with some weight loss in patients with T2DM and prediabetes. However, weight loss needs to be encouraged more in primary care. Future, prospective studies should further investigate weight loss in T2DM and prediabetes with orlistat, especially variation by socioeconomic characteristics.

Citation

Ghosal, S. (2023). Primary care prescribing of orlistat medication for weight management in adults with type 2 diabetes: an epidemiological study. (Thesis). Keele University

• Thesis Type: Thesis
• Deposit Date: Oct 12, 2023
• Additional Information: Embargo on access until 31 August 2025 - The thesis is due for publication, or the author is actively seeking to publish this material.
• Award Date: 2023-10