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Does the weight history of patients with newly diagnosed type 2
diabetes influence the weight changes after
diabetes diagnosis?
Niels de Fine OlivariusVolkert Siersma
Frans Boch Waldorff
Objective
To study the predictive value of patients’ weight history
before diabetes diagnosisfor
the observed weight changes after diagnosis
Study sample
Patients included in the present study (n=885)
Primary exclusions:Severe somatic disease (n=46)Severe mental illness (n=49)Declined to consent (n=59)
Newly diagnosed type 2 diabetic patients (n=1428)
Patients included at diabetes diagnosis (n=1274)
Died before follow-up (n=319)Withdrew consent ( n=34)Lost to follow-up (n=36)
Age at diagnosis = 63.2 years
Available body weights
ı ı ı ı ı
1 year beforediagnosis diabetes
diagnosis
6-yearfollow-up
10 years beforediagnosis
Age 20years
: Recalled by the patient: Measured by the doctor
Body
wei
ght (
kg)
Time in relation to diagnosis (years)Median values of weight for all patients
Weight changes before and after diabetes diagnosis
ı ı ı ı ı
: Recalled by the patient: Measured by the doctor
Body
wei
ght (
kg)
Time in relation to diagnosis (years)
W(20y)
ΔW (-10 → 1)
ΔW (-1 → 0)
ΔW (0 → 6)
Weight changes beforediabetes diagnosis
20
25
30
35
20 30 40 50 60 70 80 90 20 30 40 50 60 70 80 90
Mænd
Age (years)
BM
I (kg
/m2 )
Kvinder
-- 40-49 år-- 50-59 år-- 60-69 år-- 70-79 år- - 80+ år
Men Women
yearsyearsyearsyears
years
Age (years)
BM
I (kg
/m2 )
Weight change before and after diabetes diagnosis
ΔW (-10 → 1)ΔW (0 → 6)median, kg
Weight loss, kg≥ 105-100-5
-1.9-2.6-2.2
Weight gain, kg0-55-10> 10
-2.0-1.8-3.0
Total -2.5
ImplicationsChange in Body Weightcross-sectional, mean values
-2.5
0.0
2.5
5.0
7.5
0 3 6 9 12 15
kg
Years from randomisation
Conventional
Intensive
UKPDS
Weight change before and after diabetes diagnosis
ΔW (-10 → -1)
ΔW (0 → 6)Weight loss, kg Weight gain, kg
>10 5-10 0-5 0-5 5-10 >10
Weight loss, kg≥ 105-100-5
157
25
101349
162269
162354
51
16
827
Weight gain, kg0-55-10> 10
171931
333231
484342
424232
12108
315
Number of patients
Variability!
Possible predictor of weight change after diabetes diagnosis, ΔW (0 → 6)
SexAgeBMIΔW (-10 → -1)ΔW (-1 → 0)W(20y)Living aloneEducation
Familial disposition to DMDiagnostic plasma glucoseFasting triglyceridesTotal cholesterolUrinary albumin Resting heart rate Systolic blood pressurePhysical activitySmoking
Cardiovascular diseaseDiabetic retinopathyPeripheral neuropathyCancer (former or present)Allocation to type of care[Antidiabetic treatment at 6-year follow-up]
Predictors of ΔW (0 → 6)Multivariate analyses, p<0.01
** p<0.01 *** p<0.001 Linear regression models
Age and ΔW (0 → 6)
Time relative to diagnosis (years)
Body
wei
ght (
kg)
Age atdiagnosis:
40-50 (n=143)
50-60 (n=220)
60-70 (n=270)
80+ (n=44)
70-80 (n=208)
BMI and ΔW (0 → 6)Bo
dy w
eigh
t (kg
)
Time relative to diagnosis (years)
BMI atdiagnosis:
≥ 35 (n=131)
30-35 (n=265)
25-30 (n=336)
< 25 (n=148)
ΔW (-10 → -1) and ΔW (0 → 6)
Time relative to diagnosis (years)
Body
wei
ght (
kg)
Weight gain >2 kg (n=412)
Stable weight (n=239)
Weight loss >2 kg (n=177)
ΔW (-1 → -0) and ΔW (0 → 6)
Time relative to diagnosis (years)
Body
wei
ght (
kg)
Weight gain >2 kg (n=169)
Stable weight (n=286)Weight loss >2 kg (n=373)
Conclusions (1)
Weight changes before and after diabetes diagnosis are
subject to high interindividual variability
Conclusions (2)
Weight change after diabetes diagnosis is not predicted by weight change from
10 to 1 year before diagnosisbut
by age, BMI and weight change immediately before diagnosis
Predictors of ΔW (0 → 6)Univariate analyses, p<0.01
** p<0.01 *** p<0.001 Linear regression models
Diagnostic plasma glucose and ΔW (0 → 6)
Time relative to diagnosis (years)
Body
wei
ght (
kg)
Diagnosticplasmaglucose (mmol/l):
Red: <10 (n=148)
Blue: 10-17 (n=511)
Green: ≥ 17 (n=226)
Antidiabetic treatment at 6-year follow-up and ΔW (0 → 6)
Time relative to diagnosis (years)
Body
wei
ght (
kg) Antidiabetic
treatment at6-year follow-up:
Oral agents (n=508)Diet alone (n=264)Insulin (n=112)