1. Phentermine Use in the Obese Patient with IGT – A Case Study Presented by: Ellie R. Hethcox, MSN, ACNP-BC, DNP Student Introduction 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. References 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. Significance of Case 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% Intervention Response to Treatment 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. 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. 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. Garvey, W. T., Ryan, D. H., Henry, R., Bohannon, N. J. V., Toplak, H., Schwiers, M.,... Day, W. W. (2013). Prevention of type 2 diabetes in subjects with prediabetes and metabolic syndrome treated with phentermine and topiramate extended-release. Diabetes Care, doi:10.2337/dc13-1518 Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A G., Donato, K. A., &... Tomaselli, G. F. 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