medwireNews: Losing weight is the most powerful thing people with type 2 diabetes can do to counter the life-shortening effects of their condition, researchers say.
The results come from a model study that examined the effects of changes in BMI, glycemic control, blood pressure, and lipid levels on the life expectancy of people with type 2 diabetes.
Hui Shao (University of Florida College of Pharmacy, Gainesville, USA) presented the results at the virtual 81st scientific session of the ADA and revealed that people who changed from a BMI of 41.4 kg / m2 to a BMI of 24.3 kg / m2 changed, an average of almost 4 years of life.
However, he admitted that this was “not an easy task,” and also noted that weight loss was notoriously difficult to maintain.
“Remember, however, that any interventions aimed at reducing body weight are likely to be reducing as well [glycated hemoglobin], lower blood pressure, lower lipids, ”said the moderator.
“That is why we believe that the benefit of BMI control is actually greater than we estimated – because here we have only estimated the additional years of life that are exclusively associated with BMI control – and therefore believe that the body weight reduction in people with Type 2 diabetes and obesity should be a clinical and public health priority. “
For this study, the researchers used their previously developed and externally validated BRAVO diabetes simulation model. They calibrated the model with data from the US NHANES 2009–2010 and used data from 2015–2016 for the simulation.
The change from a BMI from 41.4 to 24.3 kg / m2 meant a shift from the average BMI of the fourth quartile to that of the first quartile, based on the data from 2015-2016. The transition from the fourth to the third (33.0 kg / m2) quartile was associated with 2 additional years of life and from the fourth to the second (28.6 kg / m2) with almost 3 additional years of life.
A change from the fourth (9.9%; 85 mmol / mol) to the third (7.7%; 61 mmol / mol) quartile of glycated hemoglobin (HbA1c) was associated with the addition of approximately 3.4 years of life. Switching from fourth to second (6.8%; 51 mmol / mol) and first (5.9%; 41 mmol / mol) quartile was associated with approximately 3.7-3.8 additional years of life, but Shao found that the benefits decreased as the HbA1c level increased closer to normal.
This therefore supports an HbA1c goal of around 7%, he said.
However, he found that the BRAVO model is based on data from ACCORD where the participants with the most intensive treatment had an increased risk of death. However, he suggested that a lower target HbA1c could be achieved without increasing the risk of death with the use of newer diabetes drugs.
Improvements in blood pressure and low-density lipoprotein cholesterol levels had less of an impact, with maximum life years gained being slightly less than 2 and 1, respectively.
Shao stressed, however, that these risk factors “are not mutually exclusive, which means that their effects add up”.
Therefore, if possible, “all four biomarker goals need to be met,” he said.
The moderator suggested that disclosing how many years of life people with diabetes could lose or gain in life based on changes in these risk factors could act as “a set of nudges” that could help motivate them to take medication consistently and Follow lifestyle advice.
However, he found that the benefits of achieving these goals decreased sharply with age; Conversely, the youngest age groups would benefit most from controlling risk factors.
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Scientific meetings of the ADA; 25-29 June 2021
