Unintentional Weight Loss from Metformin Despite Good Glycaemic Control in a Newly Diagnosed Diabetic Patient

Aim: To present a case of unintentional weight loss from Metformin despite good glycaemic control in a newly diagnosed diabetic patient.

Case Presentation: A 60-year-old previously diagnosed hypertensive and recently diagnosed type 2 diabetic patient with good glycaemic and blood pressure control presented with progressive weight loss in the last one year while on medication. Her normal state weight was 84.6kg, height 1.70m2 (BMI 29.27kg/m2) which dropped to 70kg (BMI 20.26Kg/mg2) at the point she was diagnosed with type 2 diabetes mellitus (T2DM). She was counselled about dietary and lifestyle modification. She was then commenced on Metformin and she achieved a good blood glucose level control but her weight dropped further to 58kg despite adherence with diet and lifestyle. She was then changed to Sulphonylurea (Glipizide). She had a significant improvement in her weight which she had maintained with good glycaemic control.

Discussion: Oral hypoglycemic agents (OHAs) are the most common initial pharmacologic treatments for type 2 diabetes and they are associated with changes in weight. Sulphonylureas (SUs) are widely used in routine clini­cal practice, not only in combination with metformin, but also as first-line monotherapy. Patients often gain weight due to the side effects of current therapies, particularly SU, insulin and glitazone therapies.

Conclusion: It is important for clinicians to consider not only the antihyperglycemia effects of selected medications used in the treatment of diabetes, but also the effect they may have on the patient’s body weight.