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Randomized Controlled Trial
. 2016 Jan 25;11(1):e0146889.
doi: 10.1371/journal.pone.0146889. eCollection 2016.

Intentional Weight Loss and Longevity in Overweight Patients with Type 2 Diabetes: A Population-Based Cohort Study

Affiliations
Randomized Controlled Trial

Intentional Weight Loss and Longevity in Overweight Patients with Type 2 Diabetes: A Population-Based Cohort Study

Rasmus Køster-Rasmussen et al. PLoS One. .

Abstract

Objective: This study examined the influence of weight loss on long-term morbidity and mortality in overweight (BMI≥25 kg/m2) patients with type 2 diabetes, and tested the hypothesis that therapeutic intentional weight loss supervised by a medical doctor prolongs life and reduces the risk for cardiovascular disease in these patients.

Methods: This is a 19 year cohort study of patients in the intervention arm of the randomized clinical trial Diabetes Care in General Practice. Weight and prospective intentions for weight loss were monitored every third month for six years in 761 consecutive patients (≥40 years) newly diagnosed with diabetes in general practices throughout Denmark in 1989-92. Multivariable Cox regression was used to estimate the association between weight change during the monitoring period (year 0 to 6) and the outcomes during the succeeding 13 years (year 6 to 19) in 444 patients who were overweight at diagnosis and alive at the end of the monitoring period (year 6). The analysis was adjusted for age, sex, education, BMI at diagnosis, change in smoking, change in physical activity, change in medication, and the Charlson comorbidity 6-year score. Outcomes were from national registers.

Results: Overall, weight loss regardless of intention was an independent risk factor for increased all-cause mortality (P<0.01). The adjusted hazard ratio for all-cause mortality, cardiovascular mortality, and cardiovascular morbidity attributable to an intentional weight loss of 1 kg/year was 1.20 (95%CI 0.97-1.50, P = 0.10), 1.26 (0.93-1.72, P = 0.14), and 1.06 (0.79-1.42, P = 0.71), respectively. Limiting the analysis to include only those patients who survived the first 2 years after the monitoring period did not substantially change these estimates. A non-linear spline estimate indicated a V-like association between weight change and all-cause mortality, suggesting the best prognosis for those who maintained their weight.

Conclusions: In this population-based cohort of overweight patients with type 2 diabetes, successful therapeutic intentional weight loss, supervised by a doctor over six years, was not associated with reduced all-cause mortality or cardiovascular morbidity/mortality during the succeeding 13 years.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Timeline of the cohort study.
Patients, newly diagnosed with diabetes, were included at year 0. The exposure of interest was weight change during year 0–6 (the monitoring period). Only patients surviving the monitoring period were included in the present analyses. The follow-up period was 13 years. The hazard ratios (HR) for mortality and morbidity were also estimated separately for the first 2 years of follow-up (year 6–8) and for the remaining 11 years (year 8–19), as bias from pathological weight loss was expected to be greater during the first two years of follow-up.
Fig 2
Fig 2. Patient flow.
Fig 3
Fig 3. Weight change.
This is an example of weight monitoring in one patient. For each patient weight change was modeled as a regression line through all the recorded weights. The exposure of interest in the present cohort study was the slope (the β coefficient) of this regression line. The exposure is a continuous variable that denotes the average yearly weight change (kg/year).
Fig 4
Fig 4. Weight change and mortality among overweight diabetes patients with an ‘intention to lose weight’.
The figure demonstrates the association between the yearly weight change during the 6-year monitoring period after the diagnosis of type 2 diabetes and the subsequent 13-years HR for all-cause mortality. The y-axis is logarithmic. Black line: cubic spline estimate, 6 data driven nodes. Yellow: 95% confidence intervals. Orange: the distribution of the patient material. Red marks: median, interquartile range and min/max.

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