Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial

Diabetes Care. 2001 Oct;24(10):1711-21. doi: 10.2337/diacare.24.10.1711.

Abstract

Objective: To examine the differential effects of intensive and conventional diabetes therapy on weight gain and body composition in adults with type 1 diabetes.

Research design and methods: Between 1982 and 1989, 1,246 adults (aged 18-39 years) in the Diabetes Control and Complications Trial were randomly assigned to either conventional therapy (1-2 injections of insulin per day) or intensive therapy (multiple daily injections or continuous subcutaneous infusion with frequent blood-glucose testing). Height and weight were measured at baseline and at annual visits for an average of 6 years (range 3-9). Body composition was assessed cross-sectionally with bioelectrical impedance analysis during 1992, at which time waist and hip circumferences were measured.

Results: Intensively treated patients gained an average of 4.75 kg more than their conventionally treated counterparts (P < 0.0001). This represented excess increases in BMI of 1.5 kg/m(2) among men and 1.8 kg/m(2) among women. Growth-curve analysis showed that weight gain was most rapid during the first year of therapy. Intensive therapy patients were also more likely to become overweight (BMI >or=27.8 kg/m(2) for men, >or=27.3 kg/m(2) for women) or experience major weight gain (BMI increased >or=5 kg/m(2)). Waist-to-hip ratios, however, did not differ between treatment groups. Major weight gain was associated with higher percentages of body fat and greater fat-free mass, but among patients without major weight gain, those receiving intensive therapy had greater fat-free mass with no difference in adiposity.

Conclusions: Intensive therapy for type 1 diabetes produces substantial excess weight gain compared with conventional therapy. However, the additional weight appears to include lean tissue as well as fat.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Blood Glucose / analysis
  • Body Composition*
  • Body Constitution
  • Body Mass Index
  • Body Weight*
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diet
  • Energy Intake
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Injections
  • Insulin / administration & dosage*
  • Insulin / therapeutic use
  • Insulin Infusion Systems
  • Male
  • Weight Gain

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin