Clinical implications of intentional weight loss in people living with type 2 diabetes: A real-world database study

Abstract

Aims: This study aimed to evaluate the impact of intentional weight loss on the risk of microvascular and macrovascular complications in people with obesity and type 2 diabetes (T2D), while accounting for changes in glycaemic control.

Materials and methods: Data from adults living with obesity (body mass index [BMI] ≥30 kg/m²) and T2D were extracted from Clinical Practice Research Datalink (CPRD) Aurum database from 2006 to 2022. Incidence of microvascular (retinopathy, neuropathy, and chronic kidney disease [CKD]) and macrovascular (myocardial infarction [MI], peripheral artery disease [PAD], and stroke) complications following a 4-year intentional weight loss period were quantified, and risk of outcomes estimated using Cox proportional hazard regression.

Results: Data from 100 507 people (mean age 53.3 years; 58% male) was included. Mean [SD] relative reduction in BMI was -2.2% [9.1%] and mean [SD] absolute change in HbA_1c was 0.0% [1.9%]. Risk of composite microvascular and macrovascular complications was significantly reduced per 1% BMI reduction (hazard ratio [HR] 0.990 [95% CI 0.988, 0.992] and 0.996 [95% CI 0.994, 0.998], respectively) and per 1%-point decrease in HbA_1c (HR 0.875 [95% CI 0.866, 0.884] and 0.872 [95% CI 0.862, 0.883]). Results were consistent across all subgroups. Reductions in BMI and HbA_1c were associated with reduced risk of retinopathy, neuropathy, CKD, and PAD. Reductions in HbA_1c-only were associated with reduced risk of MI and stroke.

Conclusions: A reduction in BMI and HbA_1c by intentional weight loss, independently and concomitantly, was associated with a reduced risk of microvascular and macrovascular complications in people with obesity and T2D.

Keywords: database study; intentional weight loss; macrovascular complications; microvascular complications; obesity; type 2 diabetes.