Weight Changes in Type 2 Diabetes and Cancer Risk: A Latent Class Trajectory Model Study

Abstract

<b><i>Introduction:</i></b> Body mass index (BMI) is often elevated at type 2 diabetes (T2D) diagnosis. Using latent class trajectory modelling (LCTM) of BMI, we examined whether weight loss after diagnosis influenced cancer incidence and all-cause mortality. <b><i>Methods:</i></b> From 1995 to 2010, we identified 7,708 patients with T2D from the Salford Integrated Record database (UK) and linked to the cancer registry for information on obesity-related cancer (ORC), non-ORC; and all-cause mortality. Repeated BMIs were used to construct sex-specific latent class trajectories. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. <b><i>Results:</i></b> Four sex-specific BMI classes were identified; stable-overweight, stable-obese, obese-slightly-decreasing, and obese-steeply-decreasing; comprising 41%, 45%, 13%, and 1% of women, and 45%, 37%, 17%, and 1% of men, respectively. In women, the stable-obese class had similar ORC risks as the obese-slightly-decreasing class, whereas the stable-overweight class had lower risks. In men, the obese-slightly-decreasing class had higher risks of ORC (HR = 1.86, 95% CI: 1.05–3.32) than the stable-obese class, while the stable-overweight class had similar risks No associations were observed for non-ORC. Compared to the stable-obese class, women (HR = 1.60, 95% CI: 0.99–2.58) and men (HR = 2.37, 95% CI: 1.66–3.39) in the obese-slightly-decreasing class had elevated mortality. No associations were observed for the stable-overweight classes. <b><i>Conclusion:</i></b> Patients who lost weight after T2D diagnosis had higher risks for ORC (in men) and higher all-cause mortality (both genders) than patients with stable obesity.

Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients

“…A limited number of studies have explored patterns of BMI growth in T2D patients. Two other studies which identified three 20 or four BMI trajectories 38 consistently found that most (82.1-91.2%) of the T2D patients were grouped into the trajectory with stable BMI, while the remaining T2D patients made up the trajectories with either increasing or decreasing BMI. These findings demonstrated that a notable proportion of T2D patients have challenges with weight control, which suggest that tracking developmental BMI trajectories since T2D diagnosis is crucial and helps emphasize efficient weight management in diabetes care.…”