<p>Impact of Weight Change in Adults with Type 2 Diabetes Mellitus: A Literature Review and Critical Analysis</p>

Abstract

Objective: Weight reduction is a key component of diabetes management in adults with type 2 diabetes mellitus (T2DM), yet the benefits of weight loss in T2DM patients have been difficult to quantify. We examined the medical literature regarding the relationships between weight change and 1) glycemic control and 2) cost and resource use. Methods: Systematic searches were conducted in the electronic databases Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify publications regarding the impact of weight change on T2DM outcomes from 2007 onward. Identified publications were screened for relevance against predefined eligibility criteria, and methodological approaches and results were extracted. Evidence for the impact of weight change on outcomes was evaluated and used to identify strengths, limitations, and gaps in the current literature. Results: The number of studies meeting eligibility criteria for each outcome was: glycemic control (n=38) and cost and resource use (n=11). The relationship between weight change and glycemic control was dependent on the interplay of multiple factors, eg, the weight loss interventions employed, the antidiabetic medication classes used, the time horizon, and baseline BMI and glycemic control. With respect to cost and resource use, the review indicated that savings were associated with weight loss, and increased costs were associated with weight gain. Conclusion: Studies regarding weight change in T2DM patients demonstrated varying effects on glycemic control and a positive association with costs and resource use, where weight loss was associated with decreased costs and resource use. Future studies may be able to clarify these relationships.

Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review

“…The highly complex relationship between weight change and medication-taking behaviors embraces many different elements, including attributes of the medication itself; PwD demographics and disease characteristics; and the attitudes, concerns, and experiences of PwD. 46 Overall, the evidence base suggests that weight concerns or actual weight change associated with T2D medication can impact medication-taking behavior at different stages of treatment: initiation, implementation/on-treatment, and discontinuation. Evidence from the broader literature regarding PwD attitudes and concerns at initiation of therapy and from the quantitative studies identified by the current literature review on discontinuation appear to present a clear story with respect to the impact of weight change.…”

“…Furthermore, adherence itself is impacted by multiple other factors, including hypoglycemia, patient–provider relationships, ability to pay, and regimen complexity. 37 , 40 , 45 , 46 …”

The Association Between Body Mass Index and Glycemic Control in Patients with Type 2 Diabetes Across Eight Countries: A Literature Review

“…We cannot conclude from the design of these cross-sectional studies that glycemic control is improved through reducing BMI. However, weight loss is known to directly impact insulin sensitivity and to preserve β-cell function [6]; and there is evidence from several longitudinal studies that the glycemic control of patients [44] reported that participants initiating a new glucose-lowering agent who lost ≥3% of their body weight from baseline to 6 months were more likely to attain their HbA 1c goal of <7% (odds ratio [OR] 3.02; 95% confidence interval [CI] 1.94-4.70) versus those who gained weight (p<0.001). Of those who lost ≥3% of their body weight, 64.2% reached HbA 1c targets compared with 33.1% who remained weight stable and 38.8% who gained weight (p<0.001).…”

“…A recent literature review [6] on the impact of weight change in adults with T2D reported mixed findings, concluding that further real-world studies were needed to advance understanding of the incremental benefits of weight loss in individuals with T2D. A key observation was that in studies included in their review, the weight-loss period evaluated was concurrent with the change in glycemic control; so the same time period was used to evaluate both the predictor and outcome variableswhereas to demonstrate a causal effect between weight change and glycemic control, the weight change would have to precede the measurement of glycemic control.…”

“…However, a large proportion of individuals are still failing to achieve glycemic control and a significant proportion of those who are not achieving glycemic control have overweight or obesity [5]. Given the close relationship between T2D and obesity, weight reduction is a key therapeutic goal in both the prevention and management of type 2 diabetes [1,6], with weight management playing a prominent role in T2D guidelines. Such guidelines outline that all individuals with T2D and overweight or obesity should be advised of the health benefits of weight loss and be encouraged to engage in a program of intensive lifestyle management to include dietary restrictions and increases in physical activity [4,7].…”