Zachary T. Bloomgarden, MD, MACE: Weight gain is, of course, an important issue in diabetes. We know that diabetes occurs on a background of obesity in so many individuals. We know that the growth in obesity in the US population, and around the world, has tracked with the increase in the prevalence of diabetes. It’s unfortunate and upsetting that many of the drugs we use in treating diabetes actually are associated with weight gain—in particular, insulin, sulfonylureas, and thiazolidinediones.
So, as a first approximation, one would say we should try to avoid the use of these agents in people with diabetes whenever possible, recognizing that because diabetes is intrinsically a disease with reduced insulin secretory capacity, there are many individuals who simply will require insulin at some point in the natural history of their disease. Also, this new information from the IRIS (Insulin Resistance Intervention after Stroke) trial of pioglitazone recognizes that this may be an insulin sensitizer which reduces the possibility of stroke and myocardial infarction, and that could well outweigh any disadvantage of weight gain.