Temporary Weight Loss Helps Type 2 Patients
Evans, Jeff, Clinical Psychiatry News
Weight loss in the years immediately following a diagnosis of type 2 diabetes is associated with significant, long-term improvement in glycemic and blood pressure control even if the weight is later regained back to baseline levels, according to a retrospective cohort study of 3-year weight trajectory patterns.
These improvements occurred in a set of patients who lost an average of 10% of their weight during the first 1.5 years of the study but then subsequently regained it by the end of the next 1.5 years. Those patients accounted for 12% of the entire cohort of 2,574 patients, whereas the rest of the cohort included patients who gained weight (300 patients, 12%) or maintained a stable weight that was relatively high (418 patients, 16%) or low (1,542 patients, 60%) during the course of the study period.
"Practitioners frustrated by the frequency of weight regain may be reinvigorated by our finding that weight regain in diabetes may not imply lack of therapeutic benefits of weight loss," Dr. Adrianne C. Feldstein and her colleagues at Kaiser Permanente Northwest Region, Portland, Ore., wrote in their report (Diabetes Care 2008 Aug. 12 [doi: 10.2337/dc08-0426]).
The study involved patients in a not-for-profit HMO that covered two states in the Pacific Northwest. They had to be aged 21-75 years, newly diagnosed with type 2 diabetes during 1997-2002, and members of the HMO for at least 1 year before diagnosis and at least 3 years after diagnosis.
Compared with the group of patients who initially lost weight, patients who followed other weight trajectories were 1.5-1.8 times more likely to have hemoglobin [A.sub.1c] values greater than 7% at year 4. This association became even stronger when the investigators restricted their analysis to patients who had a true baseline Hb[A.sub.1c] measurement (rather than just their first measurement during year 1).
Patients with higher stable weight or weight-gain trajectories were 1.8 and 1.5 times more likely, respectively, to have a blood pressure of 130/80 mm Hg or greater at year 4 than were those who followed a weight-loss trajectory. …