Study Highlights

This retrospective cohort study used electronic medical records data from a health maintenance organization.
The objective of the study was to evaluate weight trajectories in the initial years after a new diagnosis of type 2 diabetes, associated demographic and comorbidity factors, and resulting glycemic and blood pressure control.
The cohort consisted of 2574 patients 21 to 75 years of age who were newly diagnosed with type 2 diabetes between 1997 and 2002.
Growth curve analyses were used to estimate 3-year weight trajectories.
Cluster analysis was used to group similar trajectories into 4 categories: higher stable weight (n = 418; 16.2%), lower stable weight (n = 1542; 59.9%), weight gain (n = 300; 11.7%), and weight loss (n = 314; 12.2%).
Category characteristics were compared, and year 4 above-goal HbA1c levels and blood pressure were predicted by group.
Mean weight loss by 18 months in the weight loss group was 10.7 kg (–9.8%; P < .001), but this group began regaining weight, on average, at approximately 18 months.
By 36 months, there was near-complete weight regain in the weight loss group.
After adjustment for age, sex, baseline control, and related medication use, the higher stable weight group, lower stable weight group, and weight gain group were more likely than the weight loss group to have poor glycemic control, reflected in above-goal HbA1c levels.
ORs for above-goal HbA1c levels were 1.66 (95% CI, 1.12 - 2.47) for the higher stable weight group, 1.52 (95% CI, 1.08 - 2.14) for the lower stable weight group, and 1.77 (95% CI, 1.15 - 2.72) for the weight gain group.
Baseline BMI alone did not significantly predict above-goal HbA1c levels in year 4.
Compared with weight losers, those with higher stable weight or weight-gain patterns were more likely to have above-goal blood pressure (OR, 1.83; 95% CI, 1.31 - 2.57; OR, 1.47; 95% CI, 1.03 - 2.10), respectively.
The investigators concluded that weight loss after a new diagnosis of type 2 diabetes predicted improved glycemic and blood pressure control despite weight regain and that the initial period after diagnosis may be a crucial time to apply weight loss treatments to improve risk factor control.
Study limitations include lack of generalizability to other clinical settings; study only of survivors, precluding knowledge of weight change patterns for others; data collected during clinical care and not during a clinical trial; inability to evaluate possible mechanisms of improved HbA1c levels and blood pressure control in the weight loss group; and lack of data on what behaviors led to weight change.