OBESITY AND DIABETES: A REËVALUATION

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Abstract
The importance of weight reduction in controlling maturity-onset, mild, obese diabetics needs reemphasis because of the widespread use and abuse of oral hypoglycemic agents. Proof of the frequent amelioration or total reversal of the diabetic state and of improvement in the over-all health status by correction of concomitant obesity is irrefutable. In the treatment of obesity-diabetes, a practical and effective substitute, for both patient-incentive and psychiatric treatment, directed toward the obesity, is indicated more than is a substitute for insulin therapy. The latter corrects only the hyperglycemia and may, by itself, actually encourage obesity. Recent reports on the safety and anorexiant activity of phenmetrazine hydrochloride suggested that drug for a controlled investigation in this type Of diabetic patient. A triple-blind study was performed, starting with 80 obese diabetic clinic patients. The third blind portion, added to the usual double-blind procedure, was total unawareness by the patients of any relationship of the medication to appetite or caloric intake. In this manner the effect of suggestion was reduced to a minimum, if not eliminated. The incidence of significant side-effects in the phenmetrazine group was 14.7%. In those completing the trial, 71.9% lost a significant amount of weight, as opposed to 12% of the placebo group. Fifty per cent of the insulin-taking patients in the phenmetrazine group had their insulin dosage reduced 50 to 100%, as opposed to none of the placebo group. The value of routine utilization of a pharmacologically active anorexigenic agent such as phenmetrazine hydrochloride in the management of obesity-diabetes appears to have been established by the results obtained. At this time it would seem to be preferable to oral hypoglycemic agents in such patients.

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