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Weight loss helps type 2 diabetes patients

Weight loss helps type 2 diabetes patients

Losing weight has long-range health benefits for type 2 diabetes patients—even if the person regains the weight, according to a Kaiser Permanente Northwest study.

People who lost weight soon after a type 2 diabetes diagnosis were in better control of their BP and blood sugar, the American Diabetes Association’s Diabetes Care reported in a September article about the study, “Weight Change in Diabetes and Glycemic and Blood Pressure Control.”

Gregory A. Nichols, PhD, investigator at Kaiser Permanente in Portland, OR, and coauthor of the study, says engaging a patient with a recent type 2 diabetes diagnosis is important, but a weight loss at any time is beneficial. This is especially true for the more than 20 million people in the United States with type 2 diabetes, most of whom are overweight or obese.

“The main surprise is the benefit remained, even though, on average, they gained the weight back,” Nichols says. “Weight loss, whenever it happens, or even attempts at weight loss, are worth doing.”

The study is the first to show the health benefits of losing weight even if the patient experienced weight gain later, Nichols says.

The study followed 2,574 adults with type 2 diabetes for four years. Those who lost weight, usually within an average of 18 months after diagnosis, were twice as likely to achieve their BP and blood sugar targets compared to those who didn’t lose weight.

The researchers found that the initial period after a diabetes diagnosis is “of particular interest because this may be a time of heightened patient and clinical interest in patient behavior change.”

“We’ve known for a long time that weight loss is an important component in diabetes treatment and prevention,” Adrianne Feldstein, MD, MS, an investigator at Kaiser Permanente’s Center for Health Research in Portland, OR, and the study’s lead author, said in a statement. “Now it appears there may be a critical window of opportunity following diagnosis in which some lasting gains can be achieved if people are willing to take immediate steps toward lifestyle changes.”

In the study, most patients remained at about the same weight during the first three years, but a small group of 314 patients lost an average of 23 pounds. That group was more likely to meet BP and glucose targets during the fourth year, even though most of them had regained their weight. Previous research had looked at only two points in time—the start and end of the survey. However, with Kaiser Permanente’s electronic medical record (EMR), researchers were able to keep track of patients’ weight throughout the project.

Kaiser Permanente’s EMR is physician-populated and has completely replaced paper charts. Anything that happens during a healthcare encounter goes into the EMR, including weight, labs, and pharmacy data. Patients have access to most of the EMR except for the doctors’ notes, Nichols says.

With the EMR in place, researchers received real-time data for weight, glycemic, and BP control and associated demographic and comorbidity factors. Kaiser Permanente also has a diabetes registry within the EMR, which reminds physicians of evidence-based recommendations, such as medications and tests. At the end of the study, most of the patients were near the same weight as at the beginning of the study.

This means that if not for the EMR, researchers would have just checked patients’ weight at the beginning and end of the observation period and not realized the weight loss during the process. Researchers would not have discovered the benefit of weight loss without the EMR, Nichols says.

Study included four groups

Researchers investigated weight gain and loss patterns the first three years and then glucose control tests and BP readings in the fourth year.

After first excluding patients who had conditions that might lead to unintentional weight change, such as cancer and pregnancy, the researchers divided the more than 2,500 new diabetes patients into weight-trajectory groups: higher stable weight, lower stable weight, weight gain, and weight loss. They also excluded 3,833 patients with a severe illness or condition, including cancer and pregnancy.

The researchers found that the higher stable weight and lower stable weight groups maintained their weights, whereas the weight gain patients increased from an average of 107.8 kg at the beginning to 114.7 kg at 18 months, followed by a weight loss and ending near the baseline.

The weight loss group began at an average of 109.3 kg, lost weight to 98.6 kg at 18 months, and then regained back to near the baseline weight. The study found that:

  • The weight loss group had the lowest percentage of people with above-goal HbA1c and BP
  • The weight loss group was less likely to have above-goal HbA1c than the other groups
  • The higher stable weight group was 1.7 times more likely to have above-goal HbA1c than the weight loss group
  • The lower stable weight group was 1.5 times more likely to have above-goal HbA1c than the weight loss group
  • The weight gain group was 1.8 times more likely to have above-goal HbA1c than the weight loss group

“The weight loss group, on average, began regaining at about 18 months. This suggests that the first months postdiagnosis may provide a window to capitalize upon patient and clinician motivation by actively applying weight loss interventions. However, additional support for maintaining weight loss will be important,” the authors wrote.

Kaiser Permanente programs

Kaiser Permanente offers diabetes education classes to those diagnosed with the disease. Patients learn about appropriate diet, exercise, the importance of monitoring blood sugar, and potential complications of the disease. Nichols says between 75%–80% of the patients in this study attended the free diabetes education classes.

Kaiser Permanente also offered weight loss classes called Freedom from Diet for a nominal fee. Very few patients in the study attended these classes, says Nichols.

Researchers did not investigate whether either of these programs—or any program, for that matter—particularly helped patients.

Previous studies have shown the benefits of nutritional counseling and food diaries, but this study did not separate out these programs.

Nichols says clinicians played an important part, because they were the ones who worked with patients and educated them about diabetes and weight loss benefits. A kind word from a physician goes a long way, he says.

“Physicians are busy, not just at Kaiser, but everywhere. It’s easy for them to focus on biology and laboratory and pharmacy, and sometimes forget about the patient interaction that is really important to people’s health,” Nichols says.

Why was there a benefit?

Nichols says there are two hypotheses for why patients still experienced benefits even after regaining the weight: The positive effects are long-lasting because of the patients’ metabolic memory, or the study did not last long enough, and there might be a reduction in health benefits in a fifth year.

“We have seen in other clinical trials that well after the trials have stopped that a group that was treated intensively to lower their blood sugar had longer-term benefits, even if their treatment starts to equalize later. Those who got into good control early did better 10 to 15 years out in terms of cardiovascular disease and things like that. It’s possible that that’s what we’re seeing here,” Nichols says.