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Lipodystrophy and WastingLipodystrophy and Wasting
           
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Follow up to your advice to have a glucose tolearnce or insulin resistance test
Jan 29, 2004

Hello, Dr. Moyle,

I wonder if you can clarify something for me: I asked my doctor for an insulin resistance test and glucose tolerance test recommended by you to help determine the cause of my new found truncal obesity and addition of 7 inches to my waistline (despite reasonable diet and lots of walking).

He said that, if my glucose level was within normal (it is, high normal), there is no need to do the other tests. That doesn't make complete sense to me. Can you please clarify whether the insulin resistance and glucose tolerance tests are still warranted?

Also, assume either of these tests is positive, does that mean one takes a pill each day and the stomach starts shrinking (assuming good diet and continuing to walk a lot?). Will my stomach and waistline improve on meds for insulin or glucose problems?

Many thanks.

Kind regards.

Response from Dr. Moyle

Several studies (your Doctor may be familiar with one by Carr et al, another by Hadigan et al, there are also AACTG recommendations by Dube et al) have shown that for people with HIV a random or fasting glucose only pick ups up a minority of people with glucose inolerance and even diabetes on glucose tolerance testing. Benefits of metformin on reducing abdominal fat have only been reported in those with abnormal GTT or raised fasting insulin ( Hadigan et al Metformin in the treatment of HIV lipodystrophy syndrome: A randomized controlled trial.JAMA. 2000 Jul 26; 284(4): 472-7.) I hope this helps regards Graeme Moyle


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