Intentional Weight Loss and Dose Reductions of Anti-Diabetic Medications – A Retrospective Cohort Study

BACKGROUND AND AIM: Intentional weight loss, primarily by improving insulin resistance, is known to decrease the need for anti-diabetic medications. In this study, we assess the magnitude of weight loss that resulted in dose reductions or discontinuation of anti-diabetic medications in overweight or obese patients with type 2 diabetes (DM) undergoing weight loss treatment. METHODS: Case records of 50 overweight or obese patients with DM who successfully decreased dosage or discontinued diabetes medications after losing weight via attendance at two University-based, outpatient weight management centers were analyzed. Follow-up visits, weight reduction interventions, and decisions for dose reductions or discontinuation of medications were individualized to patient needs by the treating physician. RESULTS: Mean starting BMI was 35 kg/m(2), mean age 53.4 years, and 58% were male. All 50 used at least one anti-diabetic medication (30 metformin, 39 sulfonylureas, 31 insulin, 21 sitagliptin) to manage blood sugar. Mean duration of follow-up was 30.2 months. Mean weight loss was 10.8 ± 4.1 kgs (11.1% of initial body weight ± 4.7%). 22/50 patients (44%) discontinued anti-diabetes medications (14 sulfonylureas [36%], 7 insulin [23%], 4 sitagliptin [19%]). The mean percentage weight loss achieved at the point of successful discontinuation of medication was 11.2% ± 3.5% (14% for sulphonylureas, 11% for insulin, and 7.1% for sitagliptin). Mean percentage weight loss of 5.6% ± 2.8% (5.1% for sulphonylureas, 4.3% for insulin, and 7.1% for sitagliptin) was required for initial dose reduction. For every 5% weight loss, predicted dose reductions were sulphonylureas, 39%; insulin, 42%; and any anti-diabetic medications, 49%. CONCLUSION: Among overweight or obese patients with type 2 diabetes, intentional weight loss of 7-14% was typically required for full discontinuation of at least one anti-diabetic medication. Discontinuation of insulin was achieved at a mean weight reduction of 11% of initial body weight

Inducible secretion of phytate-degrading enzymes from bacteria associated with the medical plant Rosa damascena cv. Taifi using rice bran

More than 320 bacteria were isolated from the soil (Rhizosphere, endophyte, flowers and leaves) of Rosa damascena cv. Taifi and screened for phytase activity. Phytase activity was checked for 24 isolates in Bacillus broth media supplemented with and without rice bran. Twelve (12) isolates were found with detectable phytase activities. Among them, four selective bacterial strains were active (BAFA.Taifi94, BAFA.Taifi103, BAFA.Taifi111 and BAFA.Taifi117). The phytase activity of strain BAFA.Taifi111, which was grown in the Bacillus broth media and supplemented without rice bran showed 19.7 units/ml initial growths whereas, with an induction of rice bran 37.7 units/ml was observed after 10 days in the shaker at 30°C/150 rpm. The optimum temperature for BAFA.Taifi94 and BAFA.Taifi103 was 60°C, whereas it was 70°C for BAFA.Taifi111. The stability at 80°C was exhibited by BAFA.Taifi117. The optimum pH range was pH 5-6.5 at 60°C. The obtained Bacillus species for phytase production have been induced using rice bran and their physical properties such as temperature optima, pH optima and thermo stability were found similar to the previously characterized and published or commercially available Bacillus phytases.Key words: Bacillus sp., phytase activities, soil bacteria, Bacillus broth, Bacillus broth