Small Weight Loss Provides Positive Glucose Control for T2D 

A loss of as little as 2-3% of a patient’s total body weight can help them achieve better blood glucose levels. 

It has been estimated that the number of patients with diabetes will double by the year 2030, making prevention strategies key. Most people who are diagnosed with type 2 diabetes have overweight or obesity, meaning lifestyle modifications of diet and exercise can play a preventative role.  

However, it is a struggle for many patients with type 2 diabetes to maintain their primary care physician’s goals for the specific ranges of numbers a person should be keeping. For example, according to the American Diabetes Association, ideally, the goal for HbA1c should be less than 7%. Unfortunately, it is difficult for patients to maintain a lower number of HbA1c due to the beta-cell function. The primary reason is a decreased beta-cell function responsible for losing glycemic control, resulting in difficulty maintaining a target HbA1c level.  

Recently, a meta-analysis study was conducted to analyze the measurable association between the durability of glycemic control and the body changes during treatment. The study followed up in 12 months and assessed HbA1c, body weight levels, and goal achievement rates. Four outcomes assessing therapeutic durability were extracted and synthesized by using a software called Stata statistical. This software included all the changes in HbA1c, patient’s goal achievement rates, their failure rate, and coefficient of failure, CoF. Patients were on different treatment plans. 

This plan included patients on insulin, metformin, sulfonylurea, thiazolidinediones, metformin, glucagon-like polypeptide-1 receptor agonists, surgery, sodium-glucose cotransporter-2 inhibitors, or dipeptidyl peptidase-IV inhibitors.  

The results of the research include a total of 8.9 months of treatment, with HbA1c levels declining from 8.03%, with a 95% confidence interval (CI), 7.91-8.15; I2 = 99.2%, to 7.15%, with a 95% CI, 7.02-7.27; I2 = 99.4%, and then it slowly increased up to 7.72%, with a 95% CI, 7.50-7.94; I2 = 99.0, within 5 years later. The goal achievement rate, however, did decrease from 54.8% to 19.4% after treatments. The coefficient of failure was 0.123 ± 0.022% per year with P < .001. The coefficient of failure was 0.224 ± 0.025% per year with P < .001 for weight gain, and 0.137 ± 0.034% per year with P < .001 for neutral weight and -0.024 ± 0.032% per year, with P = .450 for weight loss. The results after treatments: the coefficient of failure was 0.45% per year for insulin, 0.43% per year for sulfonylurea, 0.34% per year for thiazolidinediones, 0.29% per year for metformin, 0.16% for glucagon-like polypeptide-1 receptor agonists, 0.12% for surgery, -0.03% for sodium-glucose cotransporter-2 inhibitors and -0.21% for dipeptidyl peptidase-IV inhibitors. 

In conclusion, reducing body weight will improve A1C levels as well as glycemia. The goal was decreased HbA1c levels over time. This study proved that weight gain and neutral weight were associated with the factor of failure, while weight loss was negatively connected with the changes in HbA1c levels. There was, however, a limitation in the study, which was patient’s adherence to their medications. If patients were consistent with taking their medications daily, this would improve their observational study. Overall, the study had a reasonable time frame, different treatment options, a good number of participants, and an excellent result, proving that a little bit of decreased body weight can improve diabetes and prevent beta cell deterioration. 

Practice Pearls: 

• Patients with type 2 diabetes could lose 2-3% of their total body weight to improve HbA1c levels and prevent a decline in beta cells. 
• The goal for HbA1c is less than 6.5% or 7%; ultimately, 80.6% of the patients had higher than 7.0% after five years who did not maintain their levels. 
• Long-term weight control will prevent the beta-cell function from weakening. 

Diabetes. “Glycemic Control in Type 2 Diabetes and Its Association With Body Weight Changes.” PracticeUpdate. Diabetes. December 25, 2020. 

Tomah, Shaheen et al. “Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive, multidisciplinary weight management in patients with type 2 diabetes and obesity.” BMJ Open Diabetes Res Care. July 29, 2019. 

Anina Pham, PharmD. Candidate, Lake Erie College of Osteopathic Medicine, College of Pharmacy