Weight change after initiation of oral hypoglycemic monotherapy for diabetes predicts 5-year mortality: An observational study

Abstract

Purpose To investigate whether weight change in the first year after initiating an oral hypoglycemic agent (OHA) for type 2 diabetes treatment is associated with mortality in a national cohort. Procedures We prospectively followed Veterans Health Administration patients with type 2 diabetes initiating treatment with an OHA and not receiving any other diabetes pharmacotherapy for at least one year. Information on OHAs, weight, co-morbidities, other medications, demographics, and laboratory measurements was obtained from electronic medical records. Logistic regression was used to estimate 5-year mortality odds by weight change during the first year after OHA treatment initiation. Findings Patients (mean age 65 years, 97% male, mean BMI 32.3 kg/m2) initiating OHA monotherapy between 2003-8 totaled 145,198 (metformin n=89,111, glipizide n=27,100, glyburide n=25,226, rosiglitazone n=3,761). Most patients (65%) maintained a stable weight (change ≤ 5% from baseline) during the first year after OHA initiation. Those losing > 5% of baseline weight had a significantly higher odds of death over the subsequent 5-years ranging from 1.64 to 2.13 depending on OHA type. In the metformin group, weight gain > 5% of baseline was also associated with higher odds of 5-year mortality. The same results were obtained after conducting three sensitivity analyses that excluded patients for the following reasons: weight loss in the one year prior to OHA initiation, weight change > 100 lbs, or weight change > 50 lbs. Conclusions Weight loss was associated with higher odds of 5-year mortality among patients initiating an OHA, as was weight gain for metformin only.

Obesity and weight loss are inversely related to mortality and cardiovascular outcome in prediabetes and type 2 diabetes: data from the ORIGIN trial

“…An analysis from the Veterans Health Administration (VHA) including 145 198 patients treated with oral antidiabetic therapy showed that weight loss of >5% body weight but not weight gain was consistently associated with higher risk of 5-year mortality. 27 We have previously reported on weight change in patients with DM and CV comorbidity of the PROactive study. 28 In this patient cohort, weight loss was associated with higher mortality compared to patients with no weight loss while weight gain had no negative effect.…”

Weight change and mortality and cardiovascular outcomes in patients with new-onset diabetes mellitus: a nationwide cohort study

“…We also found that weight gain ≥ 10% was related to an unhealthy lifestyle (current smoking/heavy alcohol drinking), as indicated in Table 1 . It was previously reported that weight gain while taking metformin may be a marker for poor compliance with antidiabetic medication, which has been reported to be associated with higher mortality [ 20 ]. Weight gain may occur because of treatment with insulin or other hypoglycemic agents such as sulfonylurea.…”

Body Mass Index and Prognosis in Ischemic Stroke Patients With Type 2 Diabetes Mellitus

“…In addition, this study did not assess the muscle mass, which may be an important factor for prognosis. Third, while it is known that each category of diabetic drug may affect body weight (32), information about diabetic medications before admission was not collected. Lastly, this study may be subjected to the selection bias because a significant portion of screened patients excluded according to the inclusion criteria.…”