Moderate Weight Loss following Diabetes Diagnosis May Reduce Long-term CVD Risk

Background

The high risk of cardiovascular disease (CVD) in adults with type-2 diabetes (T2D) is already well-established. It is also known that obesity increases the risk of diabetes and CVD. The current data on the effect of weight loss on the incidence of CVD events among adults with diabetes is sparse and discrepant.

Aim

To determine the impact of weight change in the year following diabetes diagnosis on 10 year incidence of CVD events and all-cause mortality in T2D patients. The study also determined the impact of weight change on CVD risk factors [blood pressure (BP), lipids, glycosylated hemoglobin (HbA1c) levels) at year one and five.

Patient Profile

• Type-2 diabetes patients from the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge study without incident CVD in the first year of the study (age; 40-69 years; mean BMI; 33.4 kg/m² n=725)

Method

Study Design

• Observational study

Assessments

• Anthropometric, biochemical, clinical and questionnaire-based measures were evaluated at baseline (diabetes diagnosis), and at one and five years
• Proportion of weight change during the study period was assessed
• Weight change was categorized as
  • >2% gain
  • Maintained weight (≤2% gain or <2% loss)
  • ≥2% to <5% loss
  • ≥5% to <10% loss
  • ≥10% loss

Outcomes

• The hazard ratios (HRs) for weight change in the year following diabetes diagnosis and 10 year incidence of CVD (composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, revascularization, non-traumatic amputation; n = 99) and all-cause mortality (n = 95) was calculated.
• Considering the small number of CVD events in patients who lost weight, the results for ≥5% to <10% loss and ≥10% loss categories were combined as ≥5%.

Follow-Up

• Mean follow-up for the study was 9.8 years

Results

• Various CVD events observed during the study included; revascularization, myocardial infarction, stroke, CVD death
• Loss of ≥5% body weight in the year following diabetes diagnosis was associated with improved HbA1c and blood lipids and a 48% lower hazard of CVD at 10 years compared with maintaining weight {HR 0.52 (95% CI 0.32, 0.86)}.
• The associations between weight gain vs. weight maintenance and CVD (HR 0.41 {95% CI 0.15, 1.11}) and mortality (HR 1.63 {95% CI 0.83, 3.19}) were less clear.
• Weight loss was not associated with reduction in risk of all-cause mortality in the study subjects.
• Patients who lost more than ≥5% body weight had somewhat larger decreases in systolic BP at 1 year and 5 years compared with the other groups.
• As compared to patients who maintained weight, those who lost ≥ 5% body weight had lower HbA1c, diastolic BP and triacylglycerols at 1 year. These improvements were sustained at 5 years only amongst those who had lost ≥10% weight.
• Patients who had lost ≥10% weight, also had improved total cholesterol at 1 and 5 years.
• As per an analysis stratified by relevant medication use at 1 year, patients who lost ≥5% body weight had lower triacylglycerols, independent of lipid-lowering medication use.

Conclusions

• Amongst adults, ≥5% loss of body weight during the subsequent year after T2D diagnosis was associated with a lower hazard of CVD events compared with maintaining weight.
• Moderate weight loss may substantially cut down the long-term CVD reduction, and may be an achievable target for patients outside of specialist-led behavioral treatment programs.

Diabetologia. 2019; 62:1391–1402.