Efecto de la fluoxetina sobre la insulino resistencia en pacientes obesos no diabéticos / Effects of fluoxetine on insulin resistance in non diabetic patients

Fluoxetine, a serotonin re-uptake inhibitor with antidepressive and appetite reduction effects, could improve insulin sensitivity. The aim of this work was to assess this effect of fluoxetine in obese subjects. We studied 12 subjects with a body mass index over 30, with normal oral glucose tolerance test and not subjected to dietary restrictions. Insulin sensitivity using Bergman's minimal model, sex hormone binding globulin (SHBG) and insulin like growth factor binding protein 1 (BP 1) were evaluated before and after three weeks of treatment with 60 mg OD of fluoxetine. During treatment, subjects lost a mean of 1.9 kg. When compared with basal values, insulin sensitivity index (S1) improved significantly at the end of threatment (1.71ñ0.44 and 2.72ñ0.63 respectively), SHBG increased (28.9ñ5.1 and 18.2ñ3.4 nM/ml respectively) and BP 1 did not change (2.8ñ0.9 and 1.5ñ0.3 ng/ml respectively). The changes in insulin sensitivity did not correlate with weight changes (r=0.4 NS). Weight or insulin sensitivity changes did not correlate with initial degree of insulin resistance. We conclude that the improvement in insulin sensitivity elicited by fluoxetine is not related to weight changes and may be useful in the treatment of insulin resistant obese subjects

Mejoría de la insulinosensibilidad asociada al uso prolongado de acipimox en un obeso mórbido / Improvement of insulin sensitivity associated to the large use of acipimox in a morbidly obese patient

Insulin sensitivity was estimated in a morbidity obese, insulin-resistant, glucose-intolerant patient before and after 4 weeks of treatment with acipimox (250 mg t.i.d), an orally-administred, long-acting antilypolitic drug. The ensuing fall in circulating levels of fasting free fatty acids was associated with a clear amelioration of insulin resistance, as assessed by a minimal model analysis of a frequently sampled intravenous glucose tolerance test as well as by an oral glucose tolerance test. Similarly, this treatment brought about a reappearence of GH response to oral stimulation with clonidine. The evidence showing acipimox-induced amelioration of insulin resistance in this patient without diet, exercise or weight loss should encourage exploring the potential utility of this drug in this type of patient