Moderate weight change following diabetes diagnosis and 10 year incidence of cardiovascular disease and mortality.

AIMS/HYPOTHESIS: Adults with type 2 diabetes are at high risk of developing cardiovascular disease (CVD). Evidence of the impact of weight loss on incidence of CVD events among adults with diabetes is sparse and conflicting. We assessed weight change in the year following diabetes diagnosis and estimated associations with 10 year incidence of CVD events and all-cause mortality. METHODS: In a cohort analysis among 725 adults with screen-detected diabetes enrolled in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial, we estimated HRs for weight change in the year following diabetes diagnosis and 10 year incidence of CVD (n = 99) and all-cause mortality (n = 95) using Cox proportional hazards regression. We used linear regression to estimate associations between weight loss and CVD risk factors. Models were adjusted for age, sex, baseline BMI, smoking, occupational socioeconomic status, cardio-protective medication use and treatment group. RESULTS: Loss of ≥5% body weight in the year following diabetes diagnosis was associated with improvements in HbA1c and blood lipids and a lower hazard of CVD at 10 years compared with maintaining weight (HR 0.52 [95% CI 0.32, 0.86]). The associations between weight gain vs weight maintenance and CVD (HR 0.41 [95% CI 0.15, 1.11]) and mortality (HR 1.63 [95% CI 0.83, 3.19]) were less clear. CONCLUSIONS/INTERPRETATION: Among adults with screen-detected diabetes, loss of ≥5% body weight during the year after diagnosis was associated with a lower hazard of CVD events compared with maintaining weight. These results support the hypothesis that moderate weight loss may yield substantial long-term CVD reduction, and may be an achievable target outside of specialist-led behavioural treatment programmes.ADDITION–Cambridge was supported by the Wellcome Trust (grant reference no. G061895), the Medical Research Council (MRC) (grant reference no. G0001164 and MRC Epidemiology Unit programme MC_UU_12015/4), the NIHR Health Technology Assessment Programme (grant reference no. 08/116/300), NIHR Programme Grants for Applied Research (RP-PG-0606-1259), NHS Research and Development (R&D) support funding (including the Primary Care Research and Diabetes Research Networks) and the NIHR. SJG and NJW are NIHR senior investigators. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve