Evaluation of the relationship between weight change and glycemic control after initiation of antidiabetic therapy in patients with type 2 diabetes using electronic medical record data

作者：McAdam Marx Carrie^*; Mukherjee Jayanti; Bellows Brandon K; Unni Sudhir; Ye Xiangyang; Iloeje Uchenna; Brixner Diana I

来源：Diabetes Research and Clinical Practice, 2014, 103(3): 402-411.

DOI：10.1016/j.diabres.2013.12.038

• Type 2 diabetes
• HbA1c
• Weight
• Outcomes
• Electronic medical records

Aims: This study evaluates the relationship between HbA1c and weight change outcomes by anti-diabetic weight-effect properties in patients newly treated for type 2 diabetes; a relationship not previously characterized.
Methods: Electronic medical records of patients with type 2 diabetes newly prescribed antidiabetic monotherapy were assessed to identify HbA1c goal attainment [(<53 mmol/mol)] and weight change at 1-year. Anti-diabetics were categorized by weight-effect properties: weight-gain (sulfonylureas, thiazolidinediones) and weight-loss/neutral (metformin, DPP-4 inhibitors, GLP-1 agonists). Logistic regression analyses identified likelihood of attaining HbA1c goal or >= 3% weight loss by anti-diabetic category controlling for baseline characteristics. MANOVA was used to identify correlation between changes in weight and HbA1c.
Results: The study included 28,290 patients. Mean age +/- sd was 61 years +/- 11.8. Baseline HbA1c was 7.4% +/- 1.6 (57 mmol/mol +/- 17); 67.3% were prescribed a weight-loss/neutral antidiabetic. At 1-year, more patients in the weight-loss/neutral anti-diabetic category lost weight (>= 3%) than in the weight-gain anti-diabetic category (40.4% vs. 24.2%, p < 0.001) or had an HbA1c < 7.0% (< 53 mmol/mol) (71.1% vs. 63.8%, p < 0.001). Those prescribed a weight-gain anti-diabetic were 53% less likely to lose weight and 29% less likely to be at HbA1c goal than those prescribed a weight-loss/neutral anti-diabetic (p < 0.001). Weight loss and HbA1c outcomes were significantly correlated (p < 0.001).
Conclusions: Weight loss of >= 3% was associated with better glycemic control in patients newly treated for type 2 diabetes. Anti-diabetics associated with weight-loss/neutrality were associated with greater weight loss and HbA1c goal attainment and may facilitate efforts to co-manage weight and glycemia in the ambulatory-care setting.

• 出版日期2014-3