Moderate weight change following diabetes diagnosis and 10 year incidence of cardiovascular disease and mortality

Abstract

Aims/hypothesis Adults with type 2 diabetes are at high risk of developing cardiovascular disease (CVD). Evidence of the impact of weight loss on incidence of CVD events among adults with diabetes is sparse and conflicting. We assessed weight change in the year following diabetes diagnosis and estimated associations with 10 year incidence of CVD events and all-cause mortality. Methods In a cohort analysis among 725 adults with screen-detected diabetes enrolled in the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)–Cambridge trial, we estimated HRs for weight change in the year following diabetes diagnosis and 10 year incidence of CVD ( n = 99) and all-cause mortality ( n = 95) using Cox proportional hazards regression. We used linear regression to estimate associations between weight loss and CVD risk factors. Models were adjusted for age, sex, baseline BMI, smoking, occupational socioeconomic status, cardio-protective medication use and treatment group. Results Loss of ≥5% body weight in the year following diabetes diagnosis was associated with improvements in HbA 1c and blood lipids and a lower hazard of CVD at 10 years compared with maintaining weight (HR 0.52 [95% CI 0.32, 0.86]). The associations between weight gain vs weight maintenance and CVD (HR 0.41 [95% CI 0.15, 1.11]) and mortality (HR 1.63 [95% CI 0.83, 3.19]) were less clear. Conclusions/interpretation Among adults with screen-detected diabetes, loss of ≥5% body weight during the year after diagnosis was associated with a lower hazard of CVD events compared with maintaining weight. These results support the hypothesis that moderate weight loss may yield substantial long-term CVD reduction, and may be an achievable target outside of specialist-led behavioural treatment programmes. Electronic supplementary material The online version of this article (10.1007/s00125-019-4886-1) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

“…Screening for DM in individuals identified as high risk by validated DM risk scores applied to electronic primary care data is feasible and can result in more intensive treatment of CVD risk factors and reduction in CVD risk. 27,28 Patients who lost 5% body weight or greater at one year after diagnosis of DM had a 48% lower 10-year adjusted hazard of CVD incidence compared to maintained weight. 27 Weight loss can also result in remission of DM as shown in the DIRECT trial in primary care randomly assigning people with overweight/obesity and type 2 DM diagnosed in the last 6 years to a diet replacement programme or usual care.…”

“…27,28 Patients who lost 5% body weight or greater at one year after diagnosis of DM had a 48% lower 10-year adjusted hazard of CVD incidence compared to maintained weight. 27 Weight loss can also result in remission of DM as shown in the DIRECT trial in primary care randomly assigning people with overweight/obesity and type 2 DM diagnosed in the last 6 years to a diet replacement programme or usual care. In the intervention group, 24% achieved a weight loss of 15 kg or greater, 46% had DM remission compared to 0% and 4% of the usual care group at one year.…”

Weight change and sulfonylurea therapy are related to 3 year change in microvascular function in people with type 2 diabetes

“…Thresholds of benefit To further explore the association between weight change and change in microvascular function, we divided our cohort into participants who, over the 3 years of the study, had increased, decreased or stable weight, defined as 5% or less variation (loss or gain) in their weight. The 5% threshold in weight reduction has recently been shown to reduce risk of cardiovascular events in patients suffering with type 2 diabetes [21]. One hundred and ninety participants had a stable weight and 40 participants lost 5% or more of their weight (median 8% weight loss), including one participant who underwent bariatric surgery, whereas 22 participants gained 5% or more of their weight (median 7.3% weight gain).…”

Prediction of fasting plasma glucose and glycated haemoglobin using machine learning based on tongue features

“…Weight is highly correlated with the occurrence of diabetes. After the diagnosis of diabetes, weight loss of more than 5% can improve the level of HbA 1c and reduce the risk of cardiovascular disease within 10 years [22]. There is no causal relationship between hypertension and diabetes, but diabetes often leads to increased blood pressure [23].…”