Study: Type 2 Diabetes Patients Who Lost Weight Soon After Diagnosis Had Better Control
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Reviewed By Louise Chang, MD
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Aug. 12, 2008 — People diagnosed with type 2 diabetes who lose excess weight soon after their diagnosis are up to twice as likely to maintain control of their disease than those who don't lose weight or who gain weight, according to a new study.
Even if they regain the weight, as most in this study did, the benefits remain, the researchers found.
"People who lost [excess] weight were more likely to attain their blood sugar and blood pressure goals than people who gained weight or maintained a stable weight," says Gregory A. Nichols, PhD, an investigator for Kaiser Permanente's Center for Health Research in Portland, Ore., and a co-author of the study. That was no surprise, he tells WebMD, as other research has found the same.
But the surprise was finding that the benefits remained even if the weight was regained during the four-year follow up.
Weight Loss and Diabetes
Nichols and his team followed more than 2,500 adults, all members of the large Kaiser Permanente HMO, who were diagnosed with type 2 diabetes between the years 1997 and 2002. They looked at medical records to track weight, blood sugar, and blood pressure.
"We looked at their weight over three years and looked at blood sugar and blood pressure readings in the fourth year," Nichols tells WebMD.
Weight Loss and Diabetes: Study Results
The researchers found that most participants stayed at about the same weight during the study. About 76% were at a stable weight for four years, Nichols says, while about 12% gained weight.
Another 12%, or about 314 people, lost on average 23 pounds at the 18-month mark. But by 36 months, they had gained nearly all of it back, on average.
This loss and regain group was still more likely to meet their goals for blood sugar levels and blood pressure, Nichols found.
Those who got 7% or higher on a blood test called or HbA1c, which indicates average blood sugar control over the past two or three months, were considered above goal. Those whose blood pressure was at or above 130/80 were above goal.
The findings about weight loss might have gone unnoticed, Nichols says, if his team had done what he says most researchers have done — look at the weights at only the start and finish of a study.
"We used all of the weights available to plot these trajectories," he says. "That's how we were able to identify this weight loss group."
To those newly diagnosed who are overweight, Nichols says, "You shouldn't get discouraged if you regain some or all of what you lose because your blood sugar and blood pressure control may still be better."
The study is published in online in Diabetes Care, the journal of the American Diabetes Association. About 23 million people in the U.S. have diabetes, according to the American Diabetes Association.
Weight Loss and Diabetes: Pounds Come Back?
How does Nichols explain the finding that the benefits remain even as the pounds come back on?
"One possibility is, had we looked further out, the benefit may be gone," he says. "The other possibility is, there are long-term benefits to weight loss even if the weight is regained." Why? One hypothesis is "metabolic memory" — the body remembers the benefits of an intervention such as weight loss.
Another possibility is proposed by Steven Edelman, MD, professor of medicine at the University of California San Diego and director of the Diabetes Care Clinic at the Veterans Affairs Medical Center in San Diego. "Kaiser has a very good education program," he says, so the patients probably got counseling in how to take care of themselves and their diabetes.
Some of the lifestyle changes may have stuck with them, he says, even though the pounds crept back on. "These people could still be doing regular exercise but still be overweight," he says.
Weight Loss and Diabetes: Window of Opportunity
Other diabetes experts who reviewed the study for WebMD say the findings may be a wake-up call for doctors and patients alike. "The study is a reminder that we need to diagnose diabetes early, we need to treat it aggressively as soon as it is diagnosed to maintain the remission of the diabetic state," says Om Ganda, MD, a senior physician at the Joslin Diabetes Center in Boston.
The weight loss soon after the diagnosis, he says, "is like you are creating a honeymoon period" during which the diabetes is under better control than if you hadn't lost the weight.
Doctors need to stress to newly diagnosed type 2 diabetes patients that they need to "seize that opportunity" and lose weight, says Sue Kirkman, MD, vice president of clinical affairs for the American Diabetes Association. She calls it a "window of opportunity."
Patients should try to keep off the weight, she says, despite the hopeful finding that the benefits of diabetes control remain even with regain. "We don't want people to think, 'I'll lose weight' and then 'Oh, it's OK to regain.'"
The new finding may spur doctors to encourage newly diagnosed patients even more strongly to lose weight, says David Baron, MD, chief of staff at Santa Monica-UCLA Medical Center & Orthopaedic Hospital in Santa Monica, Calif. "Even if you can't maintain the weight loss results, this shows it is worth making the extra effort to lose weight as soon as you find out you have type 2 diabetes.
SOURCES: Gregory A. Nichols, PhD, investigator, Kaiser Permanente Center for Health Research, Portland, Ore. Feldstein, A. Diabetes Care, published online August 2008. David Baron, MD, chief of staff, Santa Monica-UCLA Medical Center & Orthopaedic Hospital, Santa Monica, Calif. Steven Edelman, MD, professor of medicine, University of California San Diego; director, Diabetes Care Clinic, Veterans Affairs Medical Center, San Diego. Om Ganda, MD, senior physician, Joslin Diabetes Center, Boston. Sue Kirkman, MD, vice president of clinical affairs, American Diabetes Association, Alexandria, Va.
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