The purpose of this study is to assess the relationship between magnitude of weight loss and improvement in percentage A1C (A1C%) among overweight and obese patients with type 2 diabetes mellitus (DM) undergoing weight reduction.
Methods
Case records of patients enrolled in 2 university-based weight management programs were reviewed. Patients were sampled if they had a diagnosis of DM and had at least 1 documented A1C% reduction from their baseline value. Weight loss treatment was individualized and consisted of a calorie-restricted diet, a behavior modification plan, and a plan for increasing physical activity. Patient weights were measured at bimonthly visits. A1C% was measured every 3 months.
Results
Seventy-two patients formed the study cohort. Mean baseline body mass index was 35.1 kg/m2, mean age was 52.6 years, and 59% were males. Mean starting A1C% was 8.6. Patients achieved significant mean weight loss (10.7 kg) at study exit. Weight loss of 6.5 kg (4.5% of baseline body weight), 12.2 kg (8.7%), and 15.9 kg (10.3%) was required to reduce A1C% by 0.5, 1, and 1.5, respectively, and it took a mean of 5.6, 8.7, and 10.1 months, respectively, to achieve this. After adjustment for antidiabetic medication intake, for every 10% weight loss, the predicted reduction in A1C% was 0.81.
Conclusions
Intentional weight loss of 10% can potentially decrease A1C% by 0.81 among patients with type 2 DM. This finding may be clinically useful in encouraging and counseling a patient attempting weight loss.
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References
1.
FlegalKMCarrollMDOgdenCLCurtinLR.Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235-241.
2.
Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083-1096.
3.
FinkelsteinEAFiebelkornICWangG.National medical spending attributable to overweight and obesity: how much, and who’s paying?Health Aff (Millwood). 2003;suppl Web exclusives:W3-219–W3-226.
4.
MokdadAHFordESBowmanBA. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289(1):76-79.
5.
Pi-SunyerXBlackburnGBrancatiFL. Look AHEAD Research Group. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30(6):1374-1383.
6.
KnowlerWCBarrett-ConnorEFowlerSE. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
7.
KhawKTWarehamNBinghamSLubenRWelchADayN.Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413-420.
8.
KrzentowskiGZhangLAlbertALefèbvreP.Another look at the implications of the DCCT study. Ann Endocrinol (Paris). 2004;65(5):429-435.
9.
MillerSAMancusoCABoutin-FosterC. Associations between posttraumatic stress disorder and hemoglobin A1C in low-income minority patients with diabetes. Gen Hosp Psychiatry. 2011;33(2):116-122.
RenXZhangXZhangX. Type 2 diabetes mellitus associated with increased risk for colorectal cancer: evidence from an international ecological study and population-based risk analysis in China. Public Health. 2009;123(8):540-544.
12.
SiddiquiAASpechlerSJHuertaSDredarSLittleBBCryerB.Elevated HbA1c is an independent predictor of aggressive clinical behavior in patients with colorectal cancer: a case-control study. Dig Dis Sci. 2008;53(9):2486-2494.
13.
SiddiquiAAMaddurHNaikSCryerB.The association of elevated HbA1c on the behavior of adenomatous polyps in patients with type-II diabetes mellitus. Dig Dis Sci. 2008;53(4):1042-1047.
14.
JoshuCEPrizmentAEDluzniewskiPJ. Glycated hemoglobin and cancer incidence and mortality in the atherosclerosis in communities (ARIC) study, 1990-2006 [published online ahead of print December 13, 2011]. Int J Cancer. doi:10.1002/ijc.2739410.1002/ijc.27394.
15.
SelvinENingYSteffesMW. Glycated hemoglobin and the risk of kidney disease and retinopathy in adults with and without diabetes. Diabetes. 2011;60(1):298-305.
16.
HuxleyRRAlonsoALopezFL. Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study. Heart. 2012;98(2):133-138.
17.
The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with Type 2 diabetes. N Engl J Med. 2008;358(24):2560-2572.
18.
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with Type 1 diabetes. N Engl J Med. 2005;353(25):2643-2653.
19.
RedmonJBBertoniAGConnellyS. Effect of the look AHEAD study intervention on medication use and related cost to treat cardiovascular disease risk factors in individuals with type 2 diabetes. Diabetes Care. 2010;33(6):1153-1158.
20.
AppelLJClarkJMYehHC. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959-1968.
21.
JeffreySFEleftheriaMF. Obesity. In: KasperDLBraunwaldEFauciASHauserSLLongoDLJamesonJL, eds. Harrison’s Principles of Internal Medicine. Vol. 1. 16th ed.New York, NY: McGraw Hill; 2005:422-423.
22.
Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of high Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497.
23.
HosmerDLemeshowS.Applied Logistic Regression Analysis. 2nd ed.New York, NY: John Wiley & Sons; 2000.
24.
StataCorp. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP; 2009.
25.
DeFronzoRAGoodmanAM.Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. The Multicenter Metformin Study Group. N Engl J Med. 1995;333(9):541-549.
26.
GroopL.Sulfonylureas in NIDDM. Diabetes Care. 1992;15:737-747.
27.
NathanDMBuseJBDavidsonMB. Management of hyperglycemia on type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. Diabetes Care. 2006;29:1963-1972.
28.
Van de LaarFALucassenPLAkkermansRPVan de LisdonkEHRuttenGEVan WeelC.Alpha-glucosidase inhibitors for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;(2):CD003639.
29.
SjostromLLindroosAKPeltonenM. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-2693.
30.
DixonJBO’BrienPEPlayfairJ. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299:316-323.
31.
DixonJB.Obesity and diabetes: the impact of bariatric surgery on type-2 diabetes. World J Surg. 2009;33(10):2014-2021.
32.
SumithranPPrendergastLADelbridgeE. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604.
33.
EdwardsCHindleAKFuSBrodyF.Downregulation of leptin and resistin expression in blood following bariatric surgery. Surg Endosc. 2011;25(6):1962-1968.
34.
YaoPMTabasI.Free cholesterol loading of macrophages is associated with widespread mitochondrial dysfunction and activation of the mitochondrial apoptosis pathway. J Biol Chem. 2001;276(45):42468-42476.
35.
CardellachFAlonsoJRLópezSCasademontJMiróO.Effect of smoking cessation on mitochondrial respiratory chain function. J Toxicol Clin Toxicol. 2003;41(3):223-228.
