Diabetes and CVD Mortality Linked to Weight Loss and Regain

Data analysis suggests that weight changes during weight loss attempts may raise the risk of cardiovascular disease and mortality in people with type 2 diabetes. 

Cardiovascular disease and diabetes are global health concerns. Obesity is linked to the onset of type 2 diabetes. Regardless of the degree of obesity, variations in body weight are linked to a higher risk of adverse health consequences. For patients with type 2 diabetes and overweight or obesity, the American Diabetes Association promotes weight loss strategies. While a few studies have looked at the link between body weight variability and CVD outcomes and fatalities, information on patients with type 2 diabetes is limited.

This study was conducted to determine the correlations of long-term variability in body mass index (BMI) and waist circumference (WC) with incident cardiovascular events and death and to see if these associations were influenced by lifestyle treatments aimed at weight loss in type 2 diabetes patients. The study is a cohort analysis study pulled from the Look AHEAD trial databank that included 5145 participants aged 45 to 76 years who were enrolled from August 2001 to April 2004 across 16 locations in the United States. Look AHEAD trial was a multicenter, randomized clinical trial that assessed the impact of an ILI vs. the standard of treatment (diabetes support and education [DSE]) on cardiovascular outcomes in people with type 2 diabetes and overweight or obesity. The current study only included 3604 participants who had complete BMI and Waist Circumference data at the baseline for up to 36-month visits. In addition, participants with pre-existing CVD or consent constraints were excluded from the study. Participants’ weight and height were assessed twice at each visit, using a digital scale and a standard stadiometer, respectively, and the average of these measurements was used in the analyses. Statistical Analysis was conducted using Cox proportional hazards regression models, which was beneficial in calculating the hazard ratio. 

The study had a 95 percent confidential interval for each outcome. The hazard ratios (HRs) for all-cause mortality, CVD mortality, and CVD events among DSE participants were 1.47 (95 percent CI, 1.24-1.74), 1.78 (95 percent CI, 1.26-2.53), and 1.19 (95 percent CI, 0.97-1.45), respectively, for each 3 percent rise in the CV of BMI. The HRs for all-cause mortality, CVD mortality, and CVD events were 1.23 (95 percent CI, 1.01-1.50) in the ILI group, 1.54 (95 percent CI, 1.05-2.25) in the CVD group, and 1.06 (95 percent CI, 0.86-1.31) in the CVD events group. In quartile analyses, the HRs for all-cause mortality, CVD-related mortality, and CVD events for quartile 4 compared to quartile 1 of BMI were 0.99 (95 percent CI, 0.45-2.16), 1.14 (95 percent CI, 0.12-10.53), and 0.77 (95 percent CI, 0.40-1.49), respectively. 

According to this study, weight changes during weight loss attempts among people with type 2 diabetes may have adverse health consequences. Before this study, a few studies have looked into the relationship between body weight variability and CVD outcomes in type 2 diabetes patients; however, studies about how weight reduction intervention influences this relationship are still lacking. Furthermore, the observed relationships were more extensive when the study measured adiposity using BMI rather than WC, implying that body weight changes significantly impact BMI more than WC. Some of the study’s strength was that it had a long follow-up period, a uniform examination of obesity measures, and blinded outcome assessment. However, the study’s primary limitation was that the results might not generalize to all patients with type 2 diabetes. Therefore, the sample was confined to adults with type 2 diabetes who could complete exercise testing, be motivated to participate in the trial, and be included in the Analysis. 

Practice Pearls:

• In the United States, type 2 diabetes and obesity are frequent, and body weight fluctuation is linked to a higher risk of adverse health effects.
• There is a need for evident studies to determine whether intensive weight loss interventions affect the association of variability in adiposity measures with adverse health outcomes in individuals with type 2 diabetes.
• Findings from this study imply that changes during weight loss attempts may raise cardiovascular and mortality risk in people with type 2 diabetes.

Kaze AD, Santhanam P, Erqou S, Ahima RS, Bertoni AG, Echouffo-Tcheugui JB. Bodyweight variability and risk of cardiovascular outcomes and death in weight loss intervention among patients with type 2 diabetes. JAMA Network Open. 2022;5(2). doi:10.1001/jamanetworkopen.2022.0055

Betsy Adegborioye, PharmD Candidate 2022, South College School of Pharmacy.