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BMJ Open. 2016 Jul 26;6(7):e010836. doi: 10.1136/bmjopen-2015-010836.

Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study.

Author information

  • 1School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
  • 2Department of Diabetes and Endocrinology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK.
  • 3Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
  • 4School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK Arthritis Research UK, Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
  • 5Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
  • 6Usher Institute for Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.

Abstract

OBJECTIVES:

To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes.

SETTING:

Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records.

PARTICIPANTS:

29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Weight records over time provided intrapatient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2-5 years after diagnosis) and cardiovascular events (0-5 year after diagnosis).

RESULTS:

By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation.

CONCLUSIONS:

Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor.

KEYWORDS:

PUBLIC HEALTH

PMID:
27466237
PMCID:
PMC4964186
DOI:
10.1136/bmjopen-2015-010836
[PubMed - in process]
Free PMC Article
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