Moderate weight change following diabetes diagnosis and 10 year incidence of cardiovascular disease and mortality

Jean Strelitz, Amy L Ahern, Gráinne H Long, Matthew J L Hare, Greg Irving, Clare E Boothby, Nicholas J Wareham, Simon J Griffin

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Abstract

AIMS/HYPOTHESIS: Adults with type 2 diabetes are at high risk of developing cardiovascular disease (CVD). Evidence of the impact of weight loss on incidence of CVD events among adults with diabetes is sparse and conflicting. We assessed weight change in the year following diabetes diagnosis and estimated associations with 10 year incidence of CVD events and all-cause mortality.

METHODS: In a cohort analysis among 725 adults with screen-detected diabetes enrolled in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial, we estimated HRs for weight change in the year following diabetes diagnosis and 10 year incidence of CVD (n = 99) and all-cause mortality (n = 95) using Cox proportional hazards regression. We used linear regression to estimate associations between weight loss and CVD risk factors. Models were adjusted for age, sex, baseline BMI, smoking, occupational socioeconomic status, cardio-protective medication use and treatment group.

RESULTS: Loss of ≥5% body weight in the year following diabetes diagnosis was associated with improvements in HbA1c and blood lipids and a lower hazard of CVD at 10 years compared with maintaining weight (HR 0.52 [95% CI 0.32, 0.86]). The associations between weight gain vs weight maintenance and CVD (HR 0.41 [95% CI 0.15, 1.11]) and mortality (HR 1.63 [95% CI 0.83, 3.19]) were less clear.

CONCLUSIONS/INTERPRETATION: Among adults with screen-detected diabetes, loss of ≥5% body weight during the year after diagnosis was associated with a lower hazard of CVD events compared with maintaining weight. These results support the hypothesis that moderate weight loss may yield substantial long-term CVD reduction, and may be an achievable target outside of specialist-led behavioural treatment programmes.

Original languageEnglish
Pages (from-to)1391-1402
Number of pages12
JournalDiabetologia
Volume62
Issue number8
Early online date7 May 2019
DOIs
Publication statusPublished - 31 Aug 2019

Keywords

  • Adult
  • Body Weight
  • Cardiovascular Diseases/complications
  • Cluster Analysis
  • Denmark/epidemiology
  • Diabetes Complications/mortality
  • Diabetes Mellitus, Type 2/epidemiology
  • England/epidemiology
  • Follow-Up Studies
  • Humans
  • Incidence
  • Netherlands/epidemiology
  • Observational Studies as Topic
  • Pragmatic Clinical Trials as Topic
  • Proportional Hazards Models
  • Regression Analysis
  • Remission Induction
  • Risk Factors
  • Social Class
  • Treatment Outcome
  • Weight Gain
  • Weight Loss

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