[The treatment of the obese non-insulin-dependent patient with d-fenfluramine]

The authors have evaluated the efficacy of d-fenfluramine, a serotoninergic anorectic drug, in 42 obese patients with non-insulin-dependent diabetes mellitus (NIDDM) who not very responded only to the hypocaloric diet or associated therapy with oral hypoglycemic agents. The treatment with d-fenfluramine orally 15 mg twice a day for six months produced improvement of clinical and metabolic considered parameters: body mass index (BMI), waist to hip ratio (WHR), mean daily blood glucose and glycosylated hemoglobin (HBA1c) were decreased after the drug's administration. After four months withdrawal of the drug we observed a further improvement of clinical and metabolic parameters in 28.6% patients, stability of them in 38.1%, while in 33.3% subject we found worsening of the data with increased body weight and metabolic parameters. Therefore d-fenfluramine is usefull in obese patients with NIDDM: the drug produces a significant reduction of the body weight and blood glucose during its administration; its effect continues also after withdrawal: likely because it improves the compliance to adhere to the hypocaloric diet of the patients. The use of d-fenfluramine in diabetic is better then others anorectic agents for poor side effects and peculiar mechanism of action involving serotoninergic activation in the hypothalamus without catecholaminergic effects. Furthermore it directly improves insulin sensitivity in obese patients with NIDDM.