BMI Change Patterns and Disability Development of Middle-aged Adults with Diabetes: A Dual Trajectory Modeling Approach

Chiu, Ching Ju; Wray, Linda A.; Lu, Feng Hwa; Beverly, Elizabeth A.

doi:10.1007/s11606-013-2399-z

Cited by 17 publications

(15 citation statements)

References 32 publications

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“…The weight loss benefits on glycaemic control and decreased need for antihyperglycaemic therapy are well documented, 12 20 along with reduced disability risks. 5 The national Scottish guidelines recommend that obese adults with type 2 diabetes should be offered individualised interventions to encourage weight loss. 21 While we found the mean percentage weight change after 2 years was only −0.7±6.7% (persisting up to 5 years), a subgroup (36%) had lost weight by 2 years with 59.2% of them losing more than 5%; the corresponding figures by 5 years were 41% and 68%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…1 2 The Look AHEAD trial showed weight reduction improved long-term glycaemic control over 4 years in patients with a median duration of 5 years of diabetes. 3 Similarly, Feldstein et al 4 in the USA, along with others, 5 found an association between initial weight loss with improved glycaemic and blood pressure control during the fourth year of follow-up in a cohort of 2574 newly diagnosed patients with type 2 diabetes, despite weight regain after initial weight loss. Authors have speculated that the initial period after diagnosis of type 2 diabetes may be critical for early glycaemic control 6 and for applying weight loss interventions, 4 to improve glycaemia and risk factor control.…”

Section: Introductionmentioning

confidence: 87%

“…While <48 mmol/mol (or 6.5%) is an absolute target, we defined ‘control’ as HbA1c≤53 mmol/mol (or 7%), a commonly used clinical classification. 5 6 …”

Section: Methodsmentioning

confidence: 99%

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Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

et al. 2016

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ObjectivesTo determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes.SettingUsing a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records.Participants29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years.Primary and secondary outcome measuresWeight records over time provided intrapatient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis).ResultsBy 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation.ConclusionsOur results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

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Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

et al. 2016

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“…Furthermore, we found that among those participants whose BMI <24 kg/m 2 at baseline, neither the higher level nor the greater increases in BMI were associated with the development of diabetes, thus providing support for studies that indicate there are complex mechanisms at work in individuals who are normal weight or underweight but then develop diabetes. 32,33 Whether weight fluctuations or other mechanisms are associated with the development of diabetes in adults who are underweight or normal weight is an issue that needs more research attention.…”

Section: Discussionmentioning

confidence: 99%

BMI Trajectories as a Harbinger of Pre-Diabetes or Underdiagnosed Diabetes: an 18-Year Retrospective Cohort Study in Taiwan

Chiu

et al. 2016

J GEN INTERN MED

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BACKGROUND: Although prior studies have examined BMI trajectories in Western populations, little is known regarding how BMI trajectories in Asian populations vary between adults with and without diabetes. OBJECTIVE: To examine how BMI trajectories vary between those developing and not developing diabetes over 18 years in an Asian cohort. DESIGN: Multilevel modeling was used to depict levels and rates of change in BMI for up to 18 years for participants with and without self-reported physiciandiagnosed diabetes. PARTICIPANTS: We used 14,490 data points available from repeated measurements of 3776 participants aged 50+ at baseline without diabetes from a nationally representative survey of the Taiwan Longitudinal Study on Aging (TLSA1989-2007). MAIN MEASURES: We defined development of diabetes as participants who first reported diabetes diagnoses in 2007 but had no diabetes diagnoses at baseline. We defined the reference group as those participants who reported the absence of diabetes at baseline and during the entire follow-up period. KEY RESULTS: When adjusted for time-varying comorbidities and behavioral factors, higher level and constant increases in BMI were present more than 6.5 years before self-reported diabetes diagnosis. The higher BMI level associating with the development of diabetes was especially evident in females. Within 6.5 years prior to self-reported diagnosis, however, a wider range of decreases in BMI occurred (β diabetes = 1.294, P = 0.0064; β diabetes*time = 0.150, P = 0.0327; β diabetes*time 2 = −0.008, P = 0.0065). The faster rate of increases in BMI followed by a greater decline was especially prominent in males and individuals with BMI ≧24. CONCLUSIONS: An unintentional decrease in BMI in sharp contrast to the gradually rising BMI preceding that time may be an alarm for undiagnosed diabetes or a precursor to developing diabetes.

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“…Functionally independent obese elderly patients should be encouraged to maintain a healthy BW. However, compared to those who are overweight or obese, the impact of weight change in those with relatively normal weight may be complicated 64. Most of the studies reviewed suggest that poor glucose regulation is associated with weight loss 65.…”

Section: Options Of Therapy In Elderly Patientsmentioning

confidence: 99%

Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options

Du¹,

Ou²,

Beverly³

et al. 2014

CIA

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The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly. Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population. This article reviews the guidelines and studies related to older people with T2DM worldwide. A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms. In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population.

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BMI Change Patterns and Disability Development of Middle-aged Adults with Diabetes: A Dual Trajectory Modeling Approach

Cited by 17 publications

References 32 publications

Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

BMI Trajectories as a Harbinger of Pre-Diabetes or Underdiagnosed Diabetes: an 18-Year Retrospective Cohort Study in Taiwan

Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options

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