Association of weight loss and weight loss maintenance following diabetes diagnosis by screening and incidence of cardiovascular disease and all‐cause mortality: An observational analysis of the ADDITION‐Europe trial

Abstract

Aims Short‐term weight loss may lead to remission of type 2 diabetes but the effect of maintained weight loss on cardiovascular disease (CVD) is unknown. We quantified the associations between changes in weight 5 years following a diagnosis of diabetes, and incident CVD events and mortality up to 10 years after diagnosis. Materials and methods Observational analysis of the ADDITION‐Europe trial of 2730 adults with screen‐detected type 2 diabetes from the UK, Denmark and the Netherlands. We defined weight change based on the maintenance at 5 years of weight loss achieved during the year after diabetes diagnosis, and as 5‐year overall change in weight. Incident CVD events (n = 229) and all‐cause mortality (n = 225) from 5 to 10 years follow‐up were ascertained from medical records. Results Gaining >2% weight during the year after diabetes diagnosis was associated with higher hazard of all‐cause mortality versus maintaining weight [hazard ratio (95% confidence interval): 3.18 (1.30‐7.82)]. Losing ≥5% weight 1 year after diagnosis was also associated with mortality, whether or not weight loss was maintained at 5 years: 2.47 (0.99‐6.21) and 2.72 (1.17‐6.30), respectively. Losing ≥10% weight over 5 years was associated with mortality among those with body mass index <30 kg/m2 [4.62 (1.87‐11.42)]. Associations with CVD incidence were inconclusive. Conclusions Both weight loss and weight gain after screen‐detected diabetes diagnosis were associated with higher mortality, but not CVD events, particularly among participants without obesity. The clinical implications of weight loss following a diagnosis of diabetes probably depend on its magnitude and timing, and may differ by body mass index status. Personalization of weight loss advice and support may be warranted.

Precision medicine approaches in metabolic disorders and target organ damage: where are we now, and where are we going?

“…Initiatives from scientific societies are also expected to contribute to further promoting research in this area. For example, the Italian Association of Diabetologists (AMD) conducted an international survey to ascertain the opinions of physicians regarding those tailored therapeutic algorithms that have been developed by AMD [16] . Despite the inherent heterogeneity of T2D, the 452 participating physicians (the majority of whom were men and were diabetologists) widely agreed that there is a need for a personalized therapeutic approach that is accessible and easy to use [16] .…”

Weight change and risk of cardiovascular disease among adults with type 2 diabetes: more than 14 years of follow-up in the Tehran Lipid and Glucose Study

“…Despite this, we acknowledged that diabetes awareness in our population was poor at enrollment, which is consistent with previous reports in Iran [ 39 , 40 ]. Focusing on newly-diagnosed cases of T2DM, result from observational analysis of the ADDITION-Europe trial also showed that there is no evidence of a significant association between 1-year and 5-year weight change categories and incident CVD [ 18 ]; however, considering data from Cambridge center, it was shown that in addition to the significant protective effect of weight loss ≥ 5%, weight gain > 2% also had a suggestive (not statistically significant) protective association with incident CVD, during 10 years of follow-up [ 14 ]. Additionally, among Scottish and German newly-diagnosed T2DM cases, respectively, weight change and BMI change were not related to macrovascular outcomes [ 26 , 41 ].…”

“…Data from the ORIGIN trial and the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial showed significant protection for weight loss among participants with T2DM [14,15]; however, the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) trial showed a significantly increased risk of CVD among participants with weight loss [16]. Moreover, results from other studies were not statistically significant for the association of weight loss with CVD [17][18][19]. Similar to weight loss, findings for the effect of weight gain on CVD events were inconclusive among populations with T2DM, in which adverse [16,20], protective [15], and neutral [18,19] effects have been reported for weight gain all together.…”

“…Moreover, results from other studies were not statistically significant for the association of weight loss with CVD [ 17 – 19 ]. Similar to weight loss, findings for the effect of weight gain on CVD events were inconclusive among populations with T2DM, in which adverse [ 16 , 20 ], protective [ 15 ], and neutral [ 18 , 19 ] effects have been reported for weight gain all together.…”

Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

“…However, multiple studies [ 8 – 12 ] have found no effect or adverse effect of weight loss on all-cause mortality and major CV events in patients with T2DM. Weight loss is a common symptom of T2DM which is attributable to aggravated protein catabolism and muscle oxidative damage induced by hyperglycemia and hyperinsulinemia [ 13 ].…”