Idsk -- A 44-year-old female nurse presents for follow-up of hypertension and elevated blood sugars. She is currently on lisinopril with a blood pressure of 142/94 mm Hg and a body mass index of 35 kg/m2. Her previous fasting glucose was 132 mg/dL, at which time you recommended decreased carbohydrate intake and physical activity. She returns to see you with a BMI of 37, a blood sugar of 140 mg dL, and an HbA1c of 6.1%. You diagnose her with diabetes mellitus type 2 and discuss treatment options. She feels strongly about trying lifestyle modification. She asks you about drugs for weight loss. She reports to you that she has tried orlistat. You are reluctant to use sibutramine because of her blood pressure, and you have not prescribed phentermine. You recall a recent article about a drug reviewed by the Food and Drug Administration containing topiramate, and you are not familiar with the evidence of efficacy of this medication for this indication.
