Does Rimonabant Independently Affect Free Fatty Acid and Glucose Metabolism?

Context: Endocannabinoid receptor 1 blockade is proposed to improve metabolic complications of obesity via central and peripheral effects. Objective: Our objective was to test whether rimonabant improves insulin regulation of free fatty acid and glucose metabolism after controlling for fat loss. Design: This was a double-blind, placebo-controlled substudy of the visceral fat reduction assessed by computed tomography scan on rimonabant (VICTORIA) trial. Participants and Setting: Sixty-seven abdominally obese, metabolic syndrome volunteers age 35-70 yr participated at academic medical center general clinical research centers. Intervention: Intervention included a 12-month lifestyle weight management program plus rimonabant 20 mg/d or placebo. Main Outcome Measures: Body composition and two-step euglycemic, hyperinsulinemic clamp before and after intervention were performed. Insulin sensitivity was assessed as insulin concentration needed to suppress by 50% palmitate concentration [IC50(palmitate)], flux [IC(50(palmitate)f], and hepatic glucose output [IC50(HGO)] and as insulin-stimulated glucose disposal (Delta glucose disappearance per Delta insulin concentration - glucose slope). Results: Body fat decreased by 4.5 +/- 2.9% (SD) in the rimonabant and 1.9 +/- 4.5% in the placebo group (P < 0.005). The primary [improvement in IC50(palmitate) and IC(50(palmitate))f] and secondary [improvement in IC50(HGO) and glucose slope] outcomes were not significantly different between the rimonabant and placebo groups. Post hoc analyses revealed that 1) changes in body mass index (BMI) and IC50(palmitate) were correlated (P = 0.005) in the rimonabant group; this relationship was not significantly different from placebo when controlling for greater BMI loss (P = 0.5); 2) insulin-regulated glucose disposal improved in both groups (P = 0.002) and correlated with changes in BMI. Conclusions: Improvements observed in insulin regulation of free fatty acid and glucose metabolism with rimonabant treatment in humans was not greater than that predicted by weight loss alone. (J Clin Endocrinol Metab 97: 819-827, 2012)