Prediction of excessive weight gain in insulin treated patients with type 2 diabetes

J Diabetes. 2017 Apr;9(4):325-331. doi: 10.1111/1753-0407.12418. Epub 2016 Jul 20.

Abstract

Background: Weight gain is an ongoing challenge when initiating insulin therapy in patients with type 2 diabetes mellitus (T2DM). However, if prediction of insulin-associated weight gain was possible on an individual level, targeted initiatives could be implemented to reduce weight gain. The aim of the present study was to identify predictors of weight gain in insulin-treated patients with T2DM.

Methods: In all, 412 individuals with T2DM were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analog treatment regimens (biphasic, aspart, detemir). Participants with excessive weight gain were defined as the group with weight gain in the 4th quartile (>6.2 kg).We developed a pattern classification method to predict individuals prone to excessive weight gain.

Results: Over the 18-month treatment period, median weight gain among all 412 patients was 2.4 kg (95% prediction interval [PI] -5.6, 12.4 kg), whereas median weight gain for those in the upper 4th quartile (n = 103) was 8.9 kg (95% PI 6.3, 15.2 kg). No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a receiver operating characteristic area under the curve of 0.80.

Conclusions: We have developed a prediction model that could help identify a substantial proportion of individuals with T2DM prone to large weight gain during insulin therapy.

Keywords: diabetes; insulin; prediction; weight gain; 体重增加; 糖尿病; 胰岛素; 预测.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Biphasic Insulins / adverse effects
  • Biphasic Insulins / therapeutic use*
  • Blood Glucose / metabolism
  • Chi-Square Distribution
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use
  • Insulin Aspart / adverse effects
  • Insulin Aspart / therapeutic use*
  • Insulin Detemir / adverse effects
  • Insulin Detemir / therapeutic use*
  • Logistic Models
  • Male
  • Metformin / therapeutic use
  • Middle Aged
  • Prognosis
  • Time Factors
  • Treatment Outcome
  • Weight Gain / drug effects*

Substances

  • Biphasic Insulins
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin Detemir
  • Metformin
  • Insulin Aspart