The Skinny on Weight Gain With Diabetes Drugs

Is the weight gain associated with thiazolidinediones (TZDs) counterproductive to the treatment of diabetes?

- MD

The weight gain commonly associated with TZD therapy consists of a combination of increased body mass (mainly attributable to fat) and fluid retention. How much of the weight gain results from fat and how much from fluid retention can be determined only by measuring body composition (eg, with bioelectric impedance analysis, underwater weighing, dual-energy x-ray absorptiometry, or isotope dilution analysis). There is currently no way to predict in a given patient what distribution of weight gain from fat and weight gain from fluid will result when TZD therapy is initiated. However, excessive weight gain (from about 3 kg to more than 10 kg over 3 months), which occurs occasionally with TZD therapy, can generally be attributed almost completely to fluid retention.

Weight gain secondary to increased body fat is usually associated with increased insulin resistance and thus frequently has a negative impact on glycemic control. Weight gain that results from fluid retention may not adversely affect glycemic control; however, it increases the risk of congestive heart failure.

- Guenther H. Boden, MD
    Professor of Medicine
    Division of Metabolism, Diabetes, and Endocrinology
    Temple University School of Medicine
    Philadelphia