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)