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Weight loss at 1 year predicts sustained benefit, lower HbA1c in diabetes, obesity
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Patients with diabetes and obesity who lose at least 7% of their body weight at 1 year are more likely to sustain that weight loss at 5 years along with an improved cardiometabolic profile, according to an analysis of the Why WAIT trial.
Researchers analyzing the Joslin Diabetes Center’s intensive lifestyle intervention program also found that patients who regained weight at 5 years still maintained some of the cardiometabolic benefits, particularly with LDL and HDL cholesterol.
“This is the first study to show that, in real-world clinical practice, patients with diabetes and obesity can lose and maintain significant amount of weight loss for 5 years by nonsurgical intervention,” Osama Hamdy, MD, PhD, FACE, medical director of the obesity clinical program and director of the inpatient program at Joslin Diabetes Center, told Endocrine Today. “The most important observation is that patient who lose and maintain at least 7% weight loss beyond 1 year maintain most of the benefits of weight loss on HbA1c, LDL and HDL cholesterol for 5 years and on lowering blood pressure for 18 months. They also required less medication to treat diabetes, hypertension and dyslipidemia.”
Hamdy and colleagues analyzed data from 129 patients with obesity (BMI, 30-45 kg/m²) and type 1 or type 2 diabetes enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week clinical model of intensive lifestyle intervention (mean age, 54 years; mean BMI, 38.3 kg/m²; mean diabetes duration, 9.6 years). The program included medication adjustments, dietary and exercise intervention, cognitive-behavioral intervention, group education and a monthly support session. At 1 year, researchers divided participants into group A, who maintained less than 7% weight loss (n = 61), and group B (n = 68), who maintained at least 7% weight loss. The cohort was followed for 5 years.
At 12 weeks, the total cohort lost a mean of 23.8 lb (9.7% weight loss); at 5 years, total mean weight loss was 16.2 lb (6.4% weight loss). At 5 years, group A maintained a mean weight loss of 8.4 lb (3.5%), and group B maintained a mean weight loss of 23.1 lb (9%), according to researchers.
In group A, mean HbA1c fell from 7.5% to 6.7% at 12 weeks but increased to 7.7% at 1 year and 8% at 5 years. For group B, however, mean HbA1c decreased from 7.4% to 6.4% at 12 weeks, rising to 6.8% at 1 year and to 7.3% at 5 years.
“Despite weight maintenance in group B, HbA1c gradually increased over time but remained lower than baseline for 5 years,” the researchers wrote.
Patients in group A maintained improvements in LDL and HDL cholesterol, with worsening of serum triglycerides and no change in BP. Group B maintained improvement in lipid profile for 5 years and had significantly lower BP for 18 months.
In addition, the number of patients on insulin increased from 37.7% to 50.5% at 5 years for group A but fell from 47.1% to 44.1% for group B.
“This study answers for us three important questions that patients with diabetes frequently ask,” said Hamdy, also an assistant professor of medicine at Harvard Medical School. “If I lose weight and regain some weight back, do I still get any benefit? What will weight loss do for my cardiovascular risk if I work hard to maintain weight loss for the long term? Can I really lose and maintain weight loss for the long term? Now, we know that if a person loses and maintain more than 7% for a year, he or she is most likely to maintain it for a long duration.”
Hamdy said the implications of long-term weight loss on total health care and diabetes-related costs must be explored.
“Previously, we projected that savings to be around 27% and 44%, respectively, in a year, but we don't know yet the savings in real dollars in long-term, real-world practice,” he said. – by Regina Schaffer
For more information:
Osama Hamdy, MD, PhD, FACE, can be reached at the Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215; email: osama.hamdy@joslin.harvard.edu.
Disclosure: The Why WAIT program received an unrestricted grant from Novartis Nutrition and LifeScan; neither was involved in the interpretation of data for this study. Hamdy reports receiving research support or consulting for Abbott Nutrition, Merck Pharmaceutical, Metagenics and NeuroMetrix.
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