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Weight loss cuts risk of type 2 diabetes

People with hyperglycaemia losing 10% of weight cut progression risk by 85%

Louise Prime

Wednesday, 17 July 2013

Overweight people with hyperglycaemia who lost 10% of their body weight within six months of diagnosis were 85% less likely to go on to develop type 2 diabetes in the following years than those who gained weight, research has shown. The study, published online today in the Journal of General Internal Medicine, showed that tighter blood glucose control further reduced the risk of progression to diabetes.

Researchers randomised 3041 people with hyperglycaemia to either lifestyle intervention (1018 people), metformin (1036) or placebo (987); the lifestyle intervention involved being advised on better eating habits, directed to exercise 150 minutes a week, and counselled individually for the first six months and in groups thereafter. They assessed participants’ body weight loss at 6 and 12 months, their fasting glucose (FG) and haemoglobin A1c at 6 months, and their post-load glucose at 12 months.

People allocated to the lifestyle intervention who had lost weight at 6-month follow-up had a reduced risk of developing diabetes during the following 2.7 years, compared with those who had gained weight. The more weight they had lost, the greater the risk reduction. Even those who had lost less than 3% of their weight reduced their risk of developing diabetes by a third (hazard ratio 0.65). People who had lost 5-7% of their initial weight had less than half the risk of developing diabetes (HR 0.46), and those who had managed to lose 10% or more had a dramatically reduced risk (HR 0.15).

Participants who had attained optimal FG as well as losing weight had the lowest risk of developing diabetes.

The study’s authors said: “Weight and glucose at 6 and 12 months strongly predict lower subsequent diabetes risk with a lifestyle intervention; lower FG predicts lower risk even with substantial weight loss. Early reduction in glycaemia is a stronger predictor of future diabetes risk than weight loss for metformin. We offer the first evidence to guide clinicians in making interval management decisions for high-risk patients undertaking measures to prevent diabetes.”

They added: “[We’re] usually thrilled if a patient loses 3-5% of his or her body weight after six months, but based on this new knowledge, if patients aren’t losing more weight and if their glucose remains elevated, it might be time to escalate treatment by prescribing metformin.”

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