Variability in body weight and the risk of cardiovascular complications in type 2 diabetes: results from the Swedish National Diabetes Register

Ceriello, Antonio; Lucisano, Giuseppe; Prattichizzo, Francesco; Eliasson, Björn; Franzén, Stefan; Svensson, Johan; Nicolucci, Antonio

doi:10.1186/s12933-021-01360-0

Cited by 23 publications

(20 citation statements)

References 30 publications

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“…We pooled the outcomes of studies using cutoffs of 5–10% and > 10% for weight loss. Seven studies [ 24 – 26 , 32 , 33 , 36 , 37 ] reported the association of weight variability with mortality and CV events. Among them, weight variability was assessed using average successive variability (ASV), coefficient of variation, and standard deviation (SD).…”

Section: Resultsmentioning

confidence: 99%

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Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

Huang

Shi

Ren

et al. 2022

Cardiovasc Diabetol

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Background Weight management is strongly promoted for overweight or obese patients with type 2 diabetes (T2DM) by current guidelines. However, the prognostic impact of weight loss achieved without behavioural intervention on the mortality and cardiovascular (CV) outcomes in diabetic patients is still contested. Methods We searched the PubMed, Embase, and Cochrane Library databases for studies that investigated the association of weight loss or weight variability with mortality and CV outcomes. Results of studies that measured weight loss by percentage weight loss from baseline and stratified it as > 10% and 5–10% or studies that computed weight variability were pooled using random effects model. Study quality was evaluated using the Newcastle–Ottawa Scale. Results Thirty eligible studies were included in the systematic review and 13 of these were included in the meta-analysis. Large weight loss (> 10%) was associated with increased risk of all-cause mortality (pooled hazard ratio (HR) 2.27, 95% CI 1.51–3.42), composite of major CV events (pooled HR 1.71, 95% CI 1.38–2.12) and CV mortality (pooled HR 1.50, 95% CI 1.27–1.76) among T2DM patients. Moderate weight loss showed no significant association with all-cause mortality (pooled HR 1.17, 95% CI 0.97–1.41) or CV outcomes (pooled HR 1.12, 95% CI 0.94–1.33). Weight variability was associated with high hazard of all-cause mortality (pooled HR 1.54, 95% CI 1.52–1.56). Conclusions Large weight loss and large fluctuations in weight are potential markers of increased risk of mortality and CV events in T2DM patients. Maintaining a stable weight may have positive impact in these patients.

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Section: Resultsmentioning

confidence: 99%

“…In 6 studies [ 24 – 26 , 32 , 33 , 36 ] with a combined study population of 772,563, fluctuation in body weight was associated with increased all-cause mortality and major CV outcomes among T2DM patients. Another study [ 37 ] reported that high weight variability was associated with incident AF (HR [95% CI] 1.16 [1.12–1.20]).…”

Section: Resultsmentioning

confidence: 99%

Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

Huang

Shi

Ren

et al. 2022

Cardiovasc Diabetol

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“…High BWV predicted the development of cardiovascular complications such as non‐fatal myocardial infarction, non‐fatal stroke and all‐cause mortality in T2D. 59 These studies further suggest that any weight loss strategy in people with T2D should be aimed at maintaining the reduction in the long term and avoiding body weight oscillations.…”

Section: Challenges In Achieving Weight and Glycaemic Targets For Ind...mentioning

confidence: 86%

“… 56 , 57 In a real‐world study with Asian patients with T2D, BWV was associated with higher risks of myocardial infarction, stroke and all‐cause mortality. 58 A recent study 59 using data from the Swedish National Diabetes Register of 100,576 people with T2D and without prevalent cardiovascular diseases at baseline evaluated the link between visit‐to‐visit BWV and the risk of cardiovascular complications in a Caucasian population. High BWV predicted the development of cardiovascular complications such as non‐fatal myocardial infarction, non‐fatal stroke and all‐cause mortality in T2D.…”

Section: Challenges In Achieving Weight and Glycaemic Targets For Ind...mentioning

confidence: 99%

Managing weight and glycaemic targets in people with type 2 diabetes—How far have we come?

Blüher

Ceriello

Davies

et al. 2022

Endocrino Diabet & Metabol

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Introduction:As the vast majority of people with type 2 diabetes (T2D) are also overweight or obese, healthcare professionals (HCP) are faced with the task of addressing both weight management and glucose control. In this narrative review, we aim to identify the challenges of reaching and maintaining body weight targets in people with T2D and highlight current and future treatment interventions.Methods: A search of the PubMed database was conducted using the search terms "diabetes" and "weight loss."Results: According to emerging evidence, treating obesity may be antecedent to the development and progression of T2D. While clinical benefits typically set in upon achieving a weight loss of 3-5%, these benefits are progressive leading to further health improvements, and weight loss of >15% can have a disease-modifying effect in people with T2D, an outcome that up to recently could not be achieved with any blood glucose-lowering pharmacotherapy. However, advanced treatment options with weight-loss effects currently in development including the dual GIP/GLP-1 receptor agonists may enable simultaneous achievement of individual glycemic and weight goals. Conclusion:Despite considerable therapeutic progress, there is still a large unmet medical need in patients with T2D who miss their individualized glycemic and weightloss targets. Nonetheless, it is to be expected that development of future therapies and their use will favourably change the scenario of weight and glucose control in T2D.

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“…Excessive weight gain was associated with measures of subclinical atherosclerosis and predictors of cardiovascular events and with higher rates of cardiovascular events in the DCCT/EDIC studies [ 13 , 14 ]. Fluctuation of body-weight, also known as weight cycling, i.e., repeatedly losing and regaining weight [ 15 ], was shown to be an independent predictor of cardiovascular events and mortality risk in the general population [ 16 , 17 ], as well as in people with coronary artery disease [ 18 ], or type 2 diabetes [ 19 , 20 ]. Weight cycling is a potential non-traditional cardiovascular risk factor in patients with type 1 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Body-weight variability and risk of cardiovascular outcomes in patients with type 1 diabetes: a retrospective observational analysis of data from the DCCT/EDIC population

Petria

Albuquerque

Varoquaux

et al. 2022

Cardiovasc Diabetol

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Background Cardiovascular risk and body-weight management are both emerging challenges of type 1 diabetes care. We evaluated the association between intraindividual variability of body-weight and risk of cardiovascular events in people with type 1 diabetes. Methods We analyzed 1,398 participants from the DCCT/EDIC studies. Five indices of intraindividual variability of body-weight were calculated for each participant taking into account body-weight measures obtained during the DCCT follow-up (average 6 ± 2 years). The Average Successive Variability (ASV) index, the main variable of interest, was defined as the average absolute difference between successive body-weight measures. The primary outcome was a composite of major adverse cardiovascular events (MACE: nonfatal myocardial infarction or stroke, or cardiovascular death) occurring during the subsequent EDIC follow-up (20 ± 3 years). All-cause death was a secondary outcome. Risk of outcomes were assessed by Cox proportional hazards regression analyses, adjusted for traditional cardiovascular risks factors, including BMI. Results The cumulative incidence of MACE and all-cause death during follow-up were 5.6% (n = 79) and 6.8% (n = 95), respectively. The adjusted Hazard Ratio (HR) for MACE by every increase of 1 standard deviation (SD) of ASV was 1.34 (95% CI, 1.06–1.66), p = 0.01. For all-cause death, the adjusted HR for 1 SD increase of ASV was 1.25 (1.03–1.50), p = 0.03. Similar results were observed when considering the other indices of intraindividual variability of body-weight. Conclusions High body-weight variability (body-weight cycling) is associated with increased risk of MACE and all-cause death in people with type 1 diabetes, independently of the BMI and traditional cardiovascular risk factors.

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Variability in body weight and the risk of cardiovascular complications in type 2 diabetes: results from the Swedish National Diabetes Register

Cited by 23 publications

References 30 publications

Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis

Managing weight and glycaemic targets in people with type 2 diabetes—How far have we come?

Body-weight variability and risk of cardiovascular outcomes in patients with type 1 diabetes: a retrospective observational analysis of data from the DCCT/EDIC population

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