Why carry out this study? |
There is limited real-world evidence on long-term impact of weight loss on glycemic control and metabolic parameters in people with type 2 diabetes (T2D). |
The current study assesses both the short-term (1-year) and long-term (5-year) impact of weight loss in people with T2D using US claims data linked with electronic medical records (EMR). |
What was learned from the study? |
The key findings highlight the positive effects of weight loss in people with T2D and overweight or obesity and indicate that modest and sustained weight loss can lead to clinically meaningful improvements in glycemic and metabolic parameters. |
In view of these results, health care providers may consider personalizing weight-centric approaches for their patients for better management of T2D and prevention of its associated complications. |
Introduction
Methods
Study Design and Data Source
Selection Criteria
Study Population
Study Variables
Statistical Analysis
Compliance with Ethics Guidelines
Results
Demographics and Clinical Characteristics
Characteristic | 1-year follow-up (N = 1,061,354) | 5-year follow-up (N = 308,320) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Weight-change categories | ||||||||||||
Increase of > 3% | ± 3% of index value | Decrease of > 3% to < 5% | Decrease of ≥ 5% to < 10% | Decrease of ≥ 10% to < 15% | Decrease of ≥ 15% | Increase of > 3% | ± 3% of index value | Decrease of > 3% to < 5% | Decrease of ≥ 5% to < 10% | Decrease of ≥ 10% to < 15% | Decrease of ≥ 15% | |
n (%) | 214,817 (20.2%) | 572,264 (53.9%) | 112,838 (10.6%) | 113,925 (10.7%) | 29,763 (2.8%) | 17,747 (1.7%) | 70,254 (22.8%) | 101,130 (32.8%) | 35,032 (11.4%) | 60,124 (19.5%) | 25,332 (8.2%) | 16,448 (5.3%) |
Age at index date (years)a | 60.0 (12.1) | 61.8 (11.5) | 61.8 (11.6) | 61.6 (11.9) | 61.0 (12.3) | 58.7 (12.7) | 59.2 (11.1) | 61.0 (10.6) | 61.5 (10.6) | 61.7 (10.8) | 62.3 (10.9) | 62.1 (11.5) |
Weight at index date (kg)a | 92.4 (22.8) | 96.0 (23.6) | 96.7 (23.4) | 97.7 (24.2) | 100.5 (25.6) | 111.5 (29.5) | 93.6 (22.3) | 96.2 (22.7) | 96.9 (22.2) | 98.2 (22.8) | 100.1 (24.0) | 106.3 (27.4) |
Female (%) | 43.4 | 41.1 | 43.8 | 47.0 | 50.3 | 52.1 | 41.9 | 37.7 | 39.1 | 42.1 | 48.0 | 53.8 |
Race (%)b | ||||||||||||
African American | 13.3 | 12.8 | 13.1 | 12.6 | 12.0 | 11.2 | 14.1 | 13.9 | 13.5 | 13.2 | 13.0 | 14.1 |
White | 61.5 | 62.3 | 62.0 | 63.0 | 64.3 | 64.6 | 69.4 | 68.8 | 69.4 | 70.0 | 71.3 | 71.5 |
Other | 6.2 | 6.8 | 6.7 | 6.0 | 4.9 | 4.4 | 5.6 | 6.6 | 6.5 | 6.1 | 5.0 | 4.0 |
Unknown | 19.1 | 18.2 | 18.2 | 18.4 | 18.8 | 19.8 | 10.9 | 10.8 | 10.7 | 10.7 | 10.7 | 10.5 |
Geographic region (%)c | ||||||||||||
Midwest | 19.1 | 19.3 | 19.0 | 18.7 | 18.5 | 18.3 | 19.4 | 19.4 | 18.8 | 18.7 | 18.5 | 17.6 |
Northeast | 16.5 | 17.5 | 17.3 | 17.0 | 16.2 | 17.6 | 15.3 | 16.1 | 16.2 | 16.2 | 15.5 | 14.9 |
South | 47.9 | 47.0 | 46.8 | 47.5 | 48.2 | 46.7 | 49.4 | 47.7 | 47.5 | 48.1 | 49.6 | 51.0 |
West | 16.4 | 16.2 | 16.8 | 16.7 | 17.1 | 17.3 | 15.9 | 16.8 | 17.5 | 17.0 | 16.4 | 16.5 |
CCI scorea,d | 2.3 (1.9) | 2.2 (1.8) | 2.2 (1.9) | 2.3 (1.9) | 2.4 (2.0) | 2.4 (2.1) | 1.9 (1.8) | 1.8 (1.8) | 1.8 (1.8) | 1.8 (1.8) | 1.9 (1.8) | 2.0 (1.9) |
DCSI scorea,d | 2.0 (1.7) | 1.8 (1.7) | 1.9 (1.7) | 2.0 (1.7) | 2.1 (1.8) | 2.1 (1.8) | 1.5 (1.61) | 1.4 (1.6) | 1.4 (1.6) | 1.5 (1.6) | 1.5 (1.7) | 1.6 (1.7) |
Conditions of interest (%)d | ||||||||||||
Nonalcoholic steatohepatitis | 1.4 | 1.7 | 1.8 | 1.9 | 2.0 | 2.3 | 3.9 | 4.3 | 4.6 | 4.6 | 4.2 | 3.6 |
Sleep apnea | 5.4 | 5.2 | 5.4 | 5.6 | 6.2 | 9.4 | 12.9 | 11.7 | 11.1 | 11.1 | 11.7 | 14.2 |
Polycystic ovary syndrome | 0.2 | 0.2 | 0.2 | 0.3 | 0.3 | 0.5 | 0.3 | 0.3 | 0.2 | 0.2 | 0.3 | 0.4 |
Obesity | 18.5 | 18.0 | 19.4 | 20.8 | 23.8 | 30.6 | 41.3 | 37.3 | 37.2 | 37.8 | 38.9 | 42.4 |
Medications of interest (%)d | ||||||||||||
Antidepression medications | 12.6 | 9.9 | 10.4 | 12.1 | 14.5 | 16.2 | 18.0 | 14.2 | 13.8 | 15.2 | 18.1 | 23.6 |
Oral corticosteroids | 16.7 | 15.4 | 16.3 | 17.8 | 19.2 | 19.4 | 34.0 | 32.6 | 32.6 | 32.9 | 35.1 | 37.0 |
Bariatric surgery (%)d | 0.3 | 0.2 | 0.2 | 0.3 | 1.0 | 6.8 | 0.6 | 0.3 | 0.3 | 0.4 | 0.7 | 4.0 |
Weight loss medications (%)d,e | ||||||||||||
Liraglutidef | 3.2 | 3.1 | 3.6 | 4.0 | 4.5 | 4.3 | 8.6 | 7.1 | 7.6 | 8.1 | 8.8 | 9.1 |
Phentermineg | 0.6 | 0.5 | 0.6 | 0.8 | 1.3 | 1.5 | 1.5 | 1.1 | 1.1 | 1.2 | 1.3 | 2.0 |
Changes in Longitudinal Weight
Association Between Weight Loss and Glycemic Parameters
Association Between Weight Change and Metabolic Parameters
Predictors of Weight Loss
Variable | 1-year follow-up | 5-year follow-up | ||||||
---|---|---|---|---|---|---|---|---|
≥ 15% weight loss | ≥ 10% weight loss | ≥ 15% weight loss | ≥ 10% weight loss | |||||
OR (95% CI) | p value | OR (95% CI) | p value | OR (95% CI) | p value | OR (95% CI) | p value | |
Index BMI (kg/m2)a | ||||||||
25 to < 30 | 1.43 (1.31–1.57) | < 0.001 | 1.33 (1.27–1.39) | < 0.001 | 1.52 (1.38–1.66) | < 0.001 | 1.44 (1.37–1.52) | < 0.001 |
30 to < 35 | 2.18 (2.00–2.38) | < 0.001 | 1.76 (1.68–1.84) | < 0.001 | 2.56 (2.33–2.80) | < 0.001 | 2.23 (2.12–2.35) | < 0.001 |
≥ 35 | 4.82 (4.43–5.25) | < 0.001 | 2.86 (2.74–2.99) | < 0.001 | 5.34 (4.88–5.84) | < 0.001 | 3.91 (3.70–4.12) | < 0.001 |
Femalea | 1.30 (1.26–1.34) | < 0.001 | 1.31 (1.29–1.34) | < 0.001 | 1.51 (1.46–1.56) | < 0.001 | 1.41 (1.37–1.44) | < 0.001 |
Obesity | 1.05 (1.01–1.09) | 0.016 | 1.04 (1.01–1.06) | 0.004 | 0.71 (0.68–0.73) | < 0.001 | 0.73 (0.71–0.74) | < 0.001 |
Antidepressantsb | 1.30 (1.25–1.36) | < 0.001 | 1.27 (1.24–1.30) | < 0.001 | 1.40 (1.35–1.46) | < 0.001 | 1.25 (1.22–1.29) | < 0.001 |
Corticosteroidsb | 1.08 (1.04–1.12) | < 0.001 | 1.12 (1.09–1.14) | < 0.001 | 1.03 (1.00–1.07) | 0.052 | 1.03 (1.01–1.05) | 0.009 |
Weight loss medicationsb | 1.13 (1.04–1.23) | 0.004 | 1.22 (1.16–1.29) | < 0.001 | 1.06 (0.99–1.14) | 0.121 | 0.99 (0.95–1.04) | 0.704 |
Bariatric surgeryb | 16.96 (15.76–18.25) | < 0.001 | 9.56 (8.94–10.23) | < 0.001 | 8.49 (7.68–9.40) | < 0.001 | 4.91 (4.47–5.40) | < 0.001 |
DPP4 inhibitorsb | 1.11 (1.06–1.16) | < 0.001 | 1.06 (1.03–1.09) | < 0.001 | 1.08 (1.04–1.12) | < 0.001 | 1.00 (0.98–1.02) | 0.991 |
Insulinb | 0.92 (0.89–0.95) | < 0.001 | 0.97 (0.95- 0.99) | 0.014 | 0.90 (0.87–0.93) | < 0.001 | 1.04 (1.02–1.07) | < 0.001 |
SGLT2 inhibitorsb | 1.16 (1.08–1.24) | < 0.001 | 0.94 (0.91–0.98) | 0.003 | 0.98 (0.93– 1.03) | 0.316 | 0.82 (0.79–0.84) | < 0.001 |
Sulfonylureasb | 1.17 (1.12–1.21) | < 0.001 | 1.19 (1.16–1.22) | < 0.001 | 0.99 (0.95–1.02) | 0.451 | 0.98 (0.96–1.00) | 0.082 |
GLP-1 RAb | 1.08 (1.00–1.16) | 0.05 | 1.03 (0.98–1.08) | 0.27 | 1.08 (1.01–1.15) | 0.024 | 0.98 (0.94–1.03) | 0.468 |