Association between weight change and incidence of cardiovascular disease events and mortality among adults with type 2 diabetes: a systematic review of observational studies and behavioural intervention trials

Abstract

Aims/hypothesis Weight loss is often recommended in the treatment of type 2 diabetes. While evidence has shown that large weight loss may lead to diabetes remission and improvement in cardiovascular risk factors, long-term impacts are unclear. We performed a systematic review of studies of weight loss and other weight changes and incidence of CVD among people with type 2 diabetes. Methods Observational studies of behavioural (non-surgical and non-pharmaceutical) weight changes and CVD events among adults with type 2 diabetes, and trials of behavioural interventions targeting weight loss, were identified through searches of MEDLINE, EMBASE, Web of Science, CINAHL, and The Cochrane Library (CENTRAL) until 9 July 2019. Included studies reported change in weight and CVD and/or mortality outcomes among adults with type 2 diabetes. We performed a narrative synthesis of observational studies and meta-analysis of trial data. Results Of 13,227 identified articles, 17 (14 observational studies, three trials) met inclusion criteria. Weight gain (vs no change) was associated with higher hazard of CVD events (HRs [95% CIs] ranged from 1.13 [1.00, 1.29] to 1.63 [1.11, 2.39]) and all-cause mortality (HRs [95% CIs] ranged from 1.26 [1.12, 1.41] to 1.57 [1.33, 1.85]). Unintentional weight loss (vs no change) was associated with higher risks of all-cause mortality, but associations with intentional weight loss were unclear. Behavioural interventions targeting weight loss showed no effect on CVD events (pooled HR [95% CI] 0.95 [0.71, 1.27]; I2 = 50.1%). Risk of bias was moderate in most studies and was high in three studies, due to potential uncontrolled confounding and method of weight assessment. Conclusions/interpretation Weight gain is associated with increased risks of CVD and mortality, although there is a lack of data supporting behavioural weight-loss interventions for CVD prevention among adults with type 2 diabetes. Long-term follow-up of behavioural intervention studies is needed to understand effects on CVD and mortality and to inform policy concerning weight management advice and support for people with diabetes. PROSPERO registration CRD42019127304. Graphical abstract

Association between changes in bodyweight and cardiovascular disease risk factors among obese Japanese patients with type 2 diabetes

“…In addition, our data might include patients with unintentional weight loss, such as malignancy and inflammatory diseases, and this affected the result. However, a previous observational study had reported the relationship of bodyweight loss and improvement of CVD risk factors 23 , and these results are consistent with those of the present study. Furthermore, there were no data based on such a large‐scale clinical practice for Japanese patients with type 2 diabetes.…”

A systematic review of the economic value proposition for commercially available nonsurgical weight‐loss interventions

“…In fact, evidence on the ability for behavioral interventions to reduce the incidence of chronic disease (and related costs) is not compelling. To this point, a recent systematic review concluded that “behavioral interventions targeting weight loss showed no effect on CVD [cardiovascular disease] events” [61]. This calls into question all of the studies suggesting cost‐effectiveness or cost savings from behavioral interventions.…”

“…is not compelling. To this point, a recent systematic review concluded that "behavioral interventions targeting weight loss showed no effect on CVD [cardiovascular disease] events" [61].…”

Weight change and risk of obesity‐related complications: A retrospective population‐based cohort study of a UK primary care database

“…[17][18][19][20] Body weight loss of 5% to 10% is considered clinically meaningful and associated with improvements in ORCs. 4,[17][18][19][20][21][22][23][24] Although the association between decreased/increased risk of ORCs with weight loss/gain has been reported previously, [24][25][26][27][28][29] the extent to which the risk of a broad range of ORCs and different degrees of weight loss and weight increase in combination with the BMI before the weight change, is not known.…”