Accord offers Clues to Weight Gain in Newly Controlled Patients with Diabets Type 2

Patients with Diabetes Type 2 will often refuse treatment because they believe better control of diabetes as well as the medications used to achieve that control will cause them to gain weight.  People recognize that poor control of diabetes leads to loss of calories and weight loss and anticipate some weight gain when this process is corrected.  The article below recognizes characteristics of patients before treatment and medication choices during treatment may affect weight gain. They recommend clinicians recognize which patients are at high risk for weight gain and implement strategies to reduce it.  Please comment below and let us know if your experience with this.

Diabetes Care. Published online February 14, 2013. Abstract  Patient with Diabetes Type 2 are often reluctant to take medications that will lead to better control because of fear of weight gain.  I located this article which shows clinicians can help the patient mitigate the weight gain, or help with weight loss by adjusting their choice of medication.  Poor control of diabetes leads to loss of calories in the from  of glucose which leads to weight loss and it was assumed the weight gain was caused when this was corrected.  There are other causes of the weight gain which are currently being unraveled.  Please see the article below which identifies characteristics of patients before treatment as well as medication choices during treatment which affect body weight.

Weight gain from intensive glucose-lowering treatment is more likely in patients who have elevated baseline glycated hemoglobin (A1C) levels or are started on thiazolidinedione (TZD) and/or insulin therapy, researchers report.

The study, based on new data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, was published online February 14 in Diabetes Care.

“The take-away message for clinicians is that when you [have a patient] whose diabetes is uncontrolled and start controlling it fairly rapidly, [he or she is] likely to get weight gain,” lead author Vivian Fonseca, MD, from the Tulane University Health Science Center, in New Orleans, Louisiana, told Medscape Medical News.

“You want to initiate strategies that have been tried in other trials to minimize weight gain [and] give people general advice about healthy living. I believe it is possible to lose weight on insulin or TZD,” he said.

Probing Treatment-Related Growing Girth

It is well-known that intensive glucose lowering is linked with weight gain, but the reasons for this outcome remain unclear, the authors write.

To investigate this phenomenon, they performed a post hoc analysis of data from the ACCORD trial, which randomized patients with type 2 diabetes and other cardiovascular risk factors to intensive glucose lowering (an A1C target of

The researchers examined weight gain in the more than 90% of the trial participants — 4425 in the intensive-control group and 4504 in the standard-control group — with available weight and A1C values at 2 years of follow-up.

They aimed to determine whether the weight gain was explained by:

Baseline characteristics, including prior medications.

Change in A1C values.

Postrandomization medications.

Similar factors in the intensive- vs standard-glucose-control groups.

Using multivariate analysis, they found that in both study groups, baseline characteristics of younger age, male sex, Asian race, no smoking history, high A1C levels, body mass index (BMI) of 25 to 35, large waist circumference, insulin use, and metformin use were independently linked with weight gain at 2 years.

In both treatment groups, participants with the highest baseline A1C levels tended to gain weight as A1C levels improved. In contrast, participants whose A1C levels were less than 7.8% at baseline lost weight when their A1C levels dropped during treatment, although the drop in A1C and in weight were relatively small. “Thus, in clinical practice, an attempt to intensify treatment in patients with a very high A1C is likely to lead to a significant weight gain,” Dr. Fonseca and colleagues write.

Insulin and TZDs had the greatest effect on weight gain, and changes in weight were more marked among the participants in the intensive-glycemia-control group. Participants in the intensive-control group who had never previously used TZD or insulin and who began the drug combination during this trial gained 4.6 to 5.3 kg at 2 years. In contrast, participants in this group who never took insulin or TZD had an average weight loss of 2.9 kg in the first 2 years of the trial.

“That is not totally surprising, since those drugs are known to cause weight gain,” Dr. Fonseca said. “Medication use [and all these studied factors], however, accounted for less than 15% of the variability” in weight gain, he pointed out. Other factors that play a role remain to be elucidated.

“Not Really Surprising”

The weight gain with insulin and TZD and the other study findings were “not really surprising,” echoed John Buse, MD, from the University of North Carolina, Chapel Hill, in an email.
Many patient with Diabetes Type 2 refuse to take medications and are willing to have poor control to avoid the weight gain that accompanies improvement in control. Some teenagers with Diabetes type I will skip some doses of insulin to foster weight loss. This study analyzed the weight gain for Diabetes type 2 Patients when their control was suddenly improved.
“Weight gain is common in patients with type 2 diabetes whose blood sugar control is improved with certain diabetes drugs (glitazones and insulin),” he commented. “However, it should be noted that there are other drugs that are not associated with weight gain,” he added.

Although it is not likely to change clinical practice, the study does provide “more precision…about the multifactorial nature of weight gain in an important study — ACCORD,” he concluded.

The authors have disclosed no relevant financial relationships. Dr. Buse has disclosed no relevant financial relationships.

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