Abstract
AimsThe aim of this study was to explore the effect of insulin treatment initiation on weight by taking weight change prior to initiation into account.Materials and methodsWe performed an observational retrospective inception cohort study, concerning Dutch primary care. We identified all patients that initiated insulin treatment (n = 7967) and individually matched patients with a reference patient (n = 5213 pairs). We obtained estimated mean weight changes in the five years prior to five years post insulin therapy. We applied linear regression analysis on weight change in the first year after insulin therapy (T0 to T+1), with matched group as primary determinant adjusted for pre‐insulin weight change and additional covariates.ResultsEstimated mean weight increased in the five consecutive years prior to insulin therapy (−0.23 kg in year T‐5 to T‐4, 0.01 kg in year T‐4 to T‐3, 0.07 kg in year T‐3 to T‐2, 0.24 kg in year T‐2 to T‐1, and 0.46 kg in year T‐1 to T0) and continued to increase in the first year after, that is T0 to T+1, at a slightly lower rate (0.31 ± 3.9 kg). Pre‐insulin weight change had the highest explained variance and was inversely and independently associated with weight change (p < .001). Starting insulin was associated with weight increase, independent of pre‐insulin weight change (β‐adjusted 1.228, p < .001). Stratification revealed that despite having a more or less similar baseline BMI, patients with substantial weight increase showed higher estimated mean BMI’s followed by weight loss pre‐insulin. In matched references, estimated mean weight changes were negative in all years concerning the study period, indicating consistent weight loss.ConclusionsInitiation of insulin therapy was independently associated with weight increase; however, overall effect on weight was small and subject to substantial variation. Pre‐insulin weight change is identified as a relatively strong inverse determinant of weight change after insulin initiation.
Highlights
Weight change was categorized into three categories: 1] substantial weight gain (≥5 kg),6 2] moderate weight gain (1 to < 5 kg) and 3] weight gain less than 1 kg, that is either mild gain, no change or weight loss
We performed sensitivity analysis concerning weight change in the year prior to index. This was added due to the fact that insulin therapy was initiated in the time period T-1 to T0, but inherent to a new users design the exact timing of insulin initiation could not be identified.[20]
This indicates that mean weight change was 1.3 kg higher in patients that initiated insulin therapy compared to their matched references
Summary
When dietary measures and oral glucose lowering drugs (OGLDs) fail to sufficiently correct glucose dysregulation, most treatment guidelines for type 2 diabetes (T2DM) advise to start or add either an injectable glucagon-like peptide-1 analogue or insulin therapy.[1]. No strong baseline determinants have been found.[10,13] The performance of prediction models increased when variables gathered after the decision to start insulin therapy were included.[6,15] Few studies included weight change prior to the initiation of insulin therapy.[9,16,17] To the best of our knowledge, there are currently no large observational intervention studies, studying long-term information on body weight prior to the initiation of insulin therapy in primary care. We explored the effect of initiation of insulin therapy on body weight by taking weight change prior to initiation into account, using the available data of the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) cohort
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
