Even Temporary Weight Loss Helps New Type 2 Diabetic Patients

Posted Aug 18, 2008.By Jeff Evans

Weight loss in the years immediately following a diagnosis of type 2 diabetes is associated with significant, long-term improvement in glycemic and blood pressure control even if the weight is later regained back to baseline levels, according to a retrospective cohort study of 3-year weight trajectory patterns published online Aug. 12 in Diabetes Care.

These improvements occurred in a set of patients who lost an average of 10% of their weight during the first 1.5 years of the study but then subsequently regained it by the end of the next 1.5 years. Those patients accounted for 12% of the entire cohort of 2,574 patients, whereas the rest of the cohort included patients who gained weight (300 patients, 12%) or maintained a stable weight that was relatively high (418 patients, 16%) or low (1,542 patients, 60%) during the course of the study period.

"Practitioners frustrated by the frequency of weight regain may be reinvigorated by our finding that weight regain in diabetes may not imply lack of therapeutic benefits of weight loss," Dr. Adrianne C. Feldstein and her colleagues at Kaiser Permanente Northwest Region, Portland, Ore., wrote in their report (Diabetes Care 2008 Aug. 12 [doi:10.2337/dc08-0426]).

The study involved patients in a not-for-profit HMO that covered two states in the Pacific Northwest. They had to be aged 21-75 years, newly diagnosed with type 2 diabetes during 1997-2002, and members of the HMO for at least 1 year before diagnosis and at least 3 years after diagnosis.

Compared with the group of patients who initially lost weight, patients who followed other weight trajectories were 1.5-1.8 times more likely to have hemoglobin A

Patients with higher stable weight or weight-gain trajectories were 1.8 and 1.5 times more likely, respectively, to have a blood pressure of 130/80 mm Hg or greater at year 4 than were those who followed a weight-loss trajectory.

Those analyses were adjusted for age; sex; baseline HbA

Patients who had an HbA

Throughout the study, body weight was a mean of 129 kg in those who maintained a higher stable weight, and 89 kg in those who maintained a lower stable weight. Patients who lost weight started at a mean of 109 kg, reached a nadir of about 99 kg at 1.5 years, and then returned close to their baseline weight at 3 years. The other group of patients started at a mean of about 108 kg, reached about 115 kg at 1.5 years, and then lost weight during the rest of the period to return to near their baseline weight.

Although the investigators did not specifically evaluate possible mechanisms to explain their findings, they speculated that the lasting benefit of weight loss "may derive from increased insulin sensitivity remaining from weight loss; mechanisms related to ‘metabolic memory'; lifestyle changes accompanying weight loss, such as improved diet or increased activity; or other unmeasured factors that differed among the weigh-trajectory groups."

"In light of previously reported positive effects of weight loss on therapeutic outcomes in people with diabetes and our added findings of the natural history of weight loss and outcomes in the community, more focus should be placed on helping clinicians implement programs to manage weight trajectories in new diabetic patients," they concluded.

The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases.