Intentional weight loss and mortality among overweight individuals with diabetes.

Williamson, David F.; Thompson, Theodore; Thun, Michael J.; Flanders, Dana; Pamuk, Elsie R.; Byers, Tim

doi:10.2337/diacare.23.10.1499

Cited by 492 publications

(377 citation statements)

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“…Weight management 7 , especially correction of abdominal obesity 4,5 , is crucial to obtain a global cardiovascular risk reduction, and previous studies have shown that intentional weight loss is able to reduce overall and CVD mortality in patients with type-2 diabetes. 80 The ongoing CRESCENDO (Comprehensive Rimonabant Evaluation Study of Cardiovascular ENDpoints and Outcomes) RCT will assess whether rimonabant 20 mg can reduce the risk of major CVD events in 17,000 abdominally obese patients with clustering risk factors (at least half with type-2 diabetes) followed for 5 years. 81 …”

Section: Cardiovascular Studiesmentioning

confidence: 99%

Cannabinoid-1 receptor antagonists in type-2 diabetes

Scheen

2007

Best Practice & Research Clinical Endocrinology & Metab

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Type-2 diabetes is closely related to abdominal obesity and is generally associated with other cardiometabolic risk factors, resulting in a risk of major cardiovascular disease. Several animal and human observations suggest that the endocannabinoid system is over-active in the presence of abdominal obesity and/or diabetes. Both central and peripheral endocannabinoid actions, via the activation of CB1 receptors, promote weight gain and associated metabolic changes. Rimonabant, the first selective CB 1 receptor blocker in clinical use, has been shown to reduce body weight, waist circumference, triglycerides, blood pressure, insulin resistance index and C-reactive protein levels, and to increase high-density lipoprotein (HDL) cholesterol and adiponectin concentrations in both non-diabetic and diabetic overweight/obese patients. In addition, a 0.5-0.7% reduction in HbA1c levels was observed in metformin-or sulphonylurea-treated patients with type-2 diabetes and in drugnaïve diabetic patients. Almost half of the metabolic changes, including HbA1c reduction, could not be explained by weight loss, suggesting that there are direct peripheral effects. Rimonabant was generally welltolerated, and the safety profile was similar in diabetic and non-diabetic patients, with a higher incidence of depressed mood disorders, nausea and dizziness. In conclusion, the potential role of rimonabant in overweight/obese patients with type-2 diabetes and at high risk of cardiovascular disease deserves much consideration.Keywords: rimonabant ; obesity ; type-2 diabetes ; cardiovascular risk ; CB 1 receptor blocker ; endocannabinoid system. Type-2 diabetes frequently coexists with a cluster of other cardiovascular and metabolic risk factors -including abdominal obesity, low high-density lipoprotein cholesterol (HDL-C), high triglycerides, elevated blood pressure and silent inflammation -and is considered to be a cardiovascular disease (CVD) risk equivalent. 1,2 Being overweight or obese -abdominally obese in particular -increases the risk of type-2 diabetes and CVD. [3][4][5] Yet individuals with type-2 diabetes often have more difficulty in losing weight and experience weight gain associated with most antidiabetic medications. 6,7 The treatment of multiple cardiovascular and metabolic riskfactors is central to the management of diabetic patients 1,2,5,8,9 , and the importance of weight management is well recognized in type-2 diabetes. 7,10,11 Over the last two decades a new biochemical/physiological system, known as the endocannabinoid (EC) system, was discovered. 12,13 There is considerable evidence that the EC system plays a significant role in appetite drive and associated behaviours, but also in endocrine and metabolic regulation and energy balance. 14 Indeed, cannabinoid (CB) receptors, especially CB1 receptors, participate in the physiological modulation of many central and peripheral functions. 14 The tremendous advances in the understanding of the molecular basis of CB activity 15 has encouraged many pharmaceutical companie...

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Section: Cardiovascular Studiesmentioning

confidence: 99%

Cannabinoid-1 receptor antagonists in type-2 diabetes

Scheen

2007

Best Practice & Research Clinical Endocrinology & Metab

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“…Agurs-Collins et al (1997) found that weight loss through diet and exercise was significantly greater at 6 months when compared to a control group who received standard diabetes care. Intentional weight loss was also found to be associated with substantial reduction in mortality of overweight individuals with diabetes (Williamson et al, 2000). The amount of weight loss in the intervention group (À2.4 kg) resulted in a significant decrease in hemoglobin Alc (HbAlc) of 2.4%.…”

Section: Introductionmentioning

confidence: 99%

“…However, several clinical trials have documented short-term benefits of weight loss on glycemic control (Williamson et al, 2000;Hermansen et al, 2001). Agurs-Collins et al (1997) found that weight loss through diet and exercise was significantly greater at 6 months when compared to a control group who received standard diabetes care.…”

Section: Introductionmentioning

confidence: 99%

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

et al. 2004

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Background: Achieving significant weight loss and glycemic control in diabetic patients remains a challenging task. Objective: This study compared the effects of a soy-based meal replacement (MR) plan vs an individualized diet plan (IDP; as recommended by the American Diabetes Association) on weight loss and metabolic profile. Design/Subjects: A total of 104 subjects were randomized prospectively to the two treatments for a total of 12 months. Results: In all, 77 of the 104 subjects completed the study. Percentage weight loss in MR group (4.5770.81%) was significantly greater (Po0.05) than in IDP group (2.2570.72%). Fasting plasma glucose was significantly reduced in MR group (126.474.9 mg/dl) compared with IDP group (152.576.6 mg/dl, Po0.0001) at 6 months but not at 12 months. Controlling for baseline levels, hemoglobin Alc level improved by 0.4970.22% for those receiving MR when compared to IDP group (Po0.05). A greater number of subjects in MR group reduced their use of sulfonylureas (Po0.0001) and metformin (Po0.05) as compared to IDP group. High-sensitivity C-reactive protein (hs-CRP) decreased À26.3% (P ¼ 0.019) in MR group compared to À7.06% (P ¼ 0.338) in IDP group at 6 months. Similar changes were observed at 12 months with MR groups, with hs-CRP decreasing by À25.0% (P ¼ 0.019) compared to À18.7% (P ¼ 0.179) in IDP group. Conclusion: This study demonstrates that MR is a viable strategy for weight reduction in diabetic patients, resulting in beneficial changes in measures of glycemic control and reduction of medications.

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“…The on-going study PROGRESS awarded by the National Prevention Research Initiative hopes to examine the benefits, at several different levels of lifestyle interventions, of weight loss on reducing risk of developing chronic No illness unintentional loss (21) No illness, intentional loss (21) Overweight lost у2 BMI* (22) Obese, lost у2 BMI* (22) Unintentional, overweight, wt lost (23) Unintentional, obese, wt lost (23) Intentional, overweight, wt lost (23) Intentional, obese, wt lost (23) Combined studies (random effect) disease such as cancer, CVD and diabetes. This multidisciplinary approach has six phases, which will be described briefly (for more detail, see Vale et al (29) ): phase 1, systematic reviews; phase 2, qualitative analysis with three group types of focus interviews; phase 3, discrete choice experiment to examine which weight-loss interventions individuals would prefer; phase 4, econometric analysis of large-panel datasets (cancer, CHD and diabetes); phase 5, analysis of cost to the National Health Service of cancer, CHD and diabetes; phase 6, a costbenefit analysis using phases 1-5.…”

Section: Prevent Obesity Grrowing Economic Synthesis Studymentioning

confidence: 99%

Influences of weight loss on long-term diabetes outcomes

Aucott

2008

Proc. Nutr. Soc.

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Increasing rates of type 2 diabetes (T2DM) follow the obesity 'epidemic', with 86 % of patients with T2DM being overweight and over half being obese. Literature has highlighted that being overweight or obese increases the risk of diabetes. Weight loss for obese patients is associated with clinical improvements, although this evidence is mostly from short-term studies. As part of a Health Technology Assessment systematic review the long-term ( ‡ 2 years) effects of weight loss on change in diabetes-related outcome measures for those with diabetes, or risk of developing diabetes for those without diabetes, was investigated in obese individuals. Eleven studies published between 1966 and 2001 fulfilled the inclusion criteria (Caucasian, BMI > 28 kg/m 2 , adults, no eating disorders, weight loss and changes in diabetes-outcome measures). Results of these studies indicated that intentional weight loss reduces the risk of developing diabetes in the long term and those participants with T2DM often have reduced clinical symptoms and mortality risk. These results have been verified and enhanced by literature published since this review. A similar systematic review was conducted as part of a six-phase project, the PRevent Obesity GRowing Economic Synthesis Study. This review excluded BMI > 34 kg/m 2 and was restricted to lifestyle interventions (or intentional weight loss). Limited information relating to diabetes was gained, with only a non-significant increasing trend for mortality from diabetes for severe weight cycling practices being suggested. Other results indicated a relationship between weight loss and fasting plasma glucose, but because of the heterogeneity of participation groups and lack of definition in relation to diabetes this relationship was not formalised. In summary, weight loss is beneficial for long-term diabetes outcomes for overweight, obese and morbidly-obese participants. There is little research evidence for those individuals who are overweight or just obese, indicating areas of future research in terms of prevention of both obesity and diabetes. Weight loss: Overweight and/or obese: Long-term diabetesThe potential for being overweight or obese has been postulated as a genetic predisposition during the evolution of homo sapiens to protect against leaner times. Unfortunately, in the last 50 years such lean times have not been prevalent (certainly in the developed world and even now in the developing countries energy-rich foods are becoming common place) and labour-saving devices encourage more sedentary behaviour, thus tilting the whole energybalance equation. However, the obesogenic environment is more complex, involving not just genetic and environmental factors but also other interconnecting factors such as biochemical, neurological, physiological, cultural and socio-economic factors (1) . Obesity prevalence has risen alarmingly, especially in the last 20 years (Table 1), and if trends continue it has been forecast that in the UK 33% of men and 28 % of women will be obese by 2010 (2) .Along with...

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Intentional weight loss and mortality among overweight individuals with diabetes.

Cited by 492 publications

References 23 publications

Cannabinoid-1 receptor antagonists in type-2 diabetes

Cannabinoid-1 receptor antagonists in type-2 diabetes

Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein

Influences of weight loss on long-term diabetes outcomes

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