Transcript File - Eleanor R. Hethcox, ACNP

Phentermine Use in the Obese Patient with IGT – A Case Study
Presented by: Ellie R. Hethcox, MSN, ACNP-BC, DNP Student
Introduction
Intervention
According to WHO, in 2014, greater than 1.9 billion adults
worldwide were overweight. Of these over 600 million
were obese. Obesity is an epidemic in the U.S. with
greater than 34.9% of the adult population with BMI of 30
or greater. Obesity places patients at risk for type 2
diabetes, OA, gout, OSA, CVD, cancer, HTN & GERD.
The goals of early (prediabetic) glucose-directed therapies
are to normalize glucose levels, prevent or delay
progression to diabetes, prevent microvascular
complications, and modify other risk factors such as
obesity, hypertension, and dyslipidemia. Sustained loss of
5%–10% of body weight in obese and overweight patients
has proven to be effective in preventing progression from
prediabetes and MetS to type 2 diabetes.
After ruling out other possible differentials including hypothyroidism, anemia, DMII & depression, pt was dx
with class I obesity (BMI 30.0 – 34.9). Patient was then
started on a 1200 kcalorie diabetic diet with brisk walking
3X per week for 30 minutes. Phentermine 15 mg PO daily
was initiated with daily journaling of physical activities,
diet, fluid intake and weekly consultations with the APRN.
Duration of pharmacologic therapy was 12 weeks.
Response to Treatment
Significance of Case
This case is significant due to the presence of both obesity
and IGT in a young Hispanic female with a strong family
history of type 2 diabetes. Prevention of progression of IGT
to DMII is a priority for the HCP and the patient priority is
primarily weight loss and development of DMII as a
secondary concern. In my practice, this is the first case of
obesity with IGT that I have encountered.
Description of the Patient
32 y/o Hispanic female with complaint of being “too fat.” Pt
states she has tried every diet and exercise program without
lasting results. Family Hx significant for DMII, HTN, HLD
Med/surg Hx: impaired glucose tolerance, gestational
diabetes; denies any previous surgery; Height: 5’5”; weight:
182.7 lb BMI: 30.4 waistline: 40 in Social Hx : single
mother; full time employment; no drug or etoh use; ROS
positive for fatigue and weight gain; Medications: MV daily;
Tylenol 325 mg PRN ; Allergies: NKDA
24 diet recall: Total of 2100-2400 kcal daily; intake of fluids
less than 32oz- mainly colas. Protein intake: 30% fat intake:
30% carbohydrate intake: 40%
Review of the Literature
Three databases were searched including CINAHL,
pubmed and medline plus. Search terms included:
“diabetes”, “phentermine” and “obesity” and limited
from 2005 to present. Inclusion criteria included
human subjects and RCTs. All articles included had
evidence levels of I-III. Ten articles were included in
the synthesis and the evidence suggests that the use
of phentermine or phentermine with Topiramate was
safe and effective as a pharmacologic intervention in
the treatment of obesity in patients with IGT.
Discussion
Weight management in the obese patient w/ IGT
using both pharmacologic and non-pharmacologic
interventions is successful with consistent support
and counseling. Phentermine is one of several
pharmacologic interventions that is safe and effective
in treating obese patients with IGT. As a result of this
case study presentation, phentermine w/Topiramate
will also be utilized in appropriate patients.
BMI, waist circumference, CBC, liver function, lipid profile,
fasting blood glucose, HgA1c, blood pressure, heart rate
and QOL were assessed pre and 12 wks post therapy.
Side effects were minimal and resolved in 1 wk. BMI,
HgA1c, waist circumference improved.
References
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