Clinical significance of unintentional weight loss in T2D?

  • Lee AK & al.
  • J Clin Endocrinol Metab
  • 7 Oct 2019

  • International Clinical Digest
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Takeaway

  • Unintentional weight loss was linked to increased risk for cardiovascular outcomes and mortality in adults with type 2 diabetes (T2D).

Why this matters

  • Unless patients specifically report lifestyle changes, even modest weight loss may indicate declining health, meriting further investigation.

Study design

  • Data from 10,081 participants in the ADVANCE trial (591 major macrovascular events) and follow-up ADVANCE-ON (978 events).  
  • Funding: Servier; National Health and Medical Research Council of Australia.

Key results

  • At 2 years:
    • 56.7% of participants were weight-stable,
    • 4.3% and 18.4% had respective weight losses of >10% and 4%-10%, and
    • 15.4% and 5.3% had respective weight gains of 4%-10% and >10%.
  • After adjustments, >10% weight loss was strongly associated with (HRs; 95% CIs):
    • Major macrovascular events: 1.75 (1.26-2.44); 
    • Cardiovascular mortality: 2.76 (1.87-4.09); and
    • All-cause mortality: 2.79 (2.10-3.71).
  • Moderate (4%-10%) weight loss was also associated with greater all-cause mortality (HR, 1.43; 95% CI, 1.16-1.76) but not the other endpoints.
  • Large weight gain (>10%) was marginally associated with major macrovascular events (HR, 1.40; 95% CI, 1.00-1.95).

Limitations

  • No direct information regarding intentional or unintentional weight change.
  • BP and HbA1c interventions could mask weight-loss benefits.
  • No information on diet.