Abstract
ObjectiveThis study examined the influence of weight loss on long-term morbidity and mortality in overweight (BMI≥25kg/m2) patients with type 2 diabetes, and tested the hypothesis that therapeutic intentional weight loss supervised by a medical doctor prolongs life and reduces the risk for cardiovascular disease in these patients.MethodsThis is a 19 year cohort study of patients in the intervention arm of the randomized clinical trial Diabetes Care in General Practice. Weight and prospective intentions for weight loss were monitored every third month for six years in 761 consecutive patients (≥40 years) newly diagnosed with diabetes in general practices throughout Denmark in 1989–92. Multivariable Cox regression was used to estimate the association between weight change during the monitoring period (year 0 to 6) and the outcomes during the succeeding 13 years (year 6 to 19) in 444 patients who were overweight at diagnosis and alive at the end of the monitoring period (year 6). The analysis was adjusted for age, sex, education, BMI at diagnosis, change in smoking, change in physical activity, change in medication, and the Charlson comorbidity 6-year score. Outcomes were from national registers.ResultsOverall, weight loss regardless of intention was an independent risk factor for increased all-cause mortality (P<0.01). The adjusted hazard ratio for all-cause mortality, cardiovascular mortality, and cardiovascular morbidity attributable to an intentional weight loss of 1 kg/year was 1.20 (95%CI 0.97–1.50, P = 0.10), 1.26 (0.93–1.72, P = 0.14), and 1.06 (0.79–1.42, P = 0.71), respectively. Limiting the analysis to include only those patients who survived the first 2 years after the monitoring period did not substantially change these estimates. A non-linear spline estimate indicated a V-like association between weight change and all-cause mortality, suggesting the best prognosis for those who maintained their weight.ConclusionsIn this population-based cohort of overweight patients with type 2 diabetes, successful therapeutic intentional weight loss, supervised by a doctor over six years, was not associated with reduced all-cause mortality or cardiovascular morbidity/mortality during the succeeding 13 years.
Highlights
Weight loss is recognized as an important first-line treatment of overweight individuals (BMI 25 kg/m2) with type 2 diabetes
The participants in Look AHEAD were a selection of relatively healthy overweight adults with prevalent type 2 diabetes, and the authors stated that the results could not be generalized, as the participants in Look AHEAD were not representative of the background population of patients with type 2 diabetes [13]
The Diabetes Care in General Practice (DCGP) intervention consisted of structured care and individualized goal setting for risk factors and weight loss [5,16]
Summary
Weight loss is recognized as an important first-line treatment of overweight individuals (BMI 25 kg/m2) with type 2 diabetes. Weight loss is regarded by many clinicians as an effective secondary prevention for cardiovascular disease in overweight patients with diabetes. This view is supported by the favorable clinical effects of weight loss on risk factors, and by results from cohort studies, suggesting that intentional weight loss reduces mortality in these patients [6,7,8,9,10,11,12]. Results from Look AHEAD showed, that despite a greater weight loss in the intervention compared with the control group, neither mortality nor cardiovascular morbidity was reduced. The participants in Look AHEAD were a selection of relatively healthy overweight adults with prevalent type 2 diabetes, and the authors stated that the results could not be generalized, as the participants in Look AHEAD were not representative of the background population of patients with type 2 diabetes [13]
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