Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

Lorna S. Aucott; Sam Philip; Alison Avenell; Ebenezer Kolawole Afolabi; Naveed Sattar; Sarah Wild; Scottish Diabetes Research Network (SDRN) Epidemiology group

doi:10.1136/bmjopen-2015-010836

Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

Lorna S. Aucott^* (Corresponding Author), Sam Philip, Alison Avenell, Ebenezer Kolawole Afolabi, Naveed Sattar, Sarah Wild (Collaborator), Scottish Diabetes Research Network (SDRN) Epidemiology group

^*Corresponding author for this work

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Abstract

Objectives: To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes.Setting: Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records.Participants: 29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years. Primary and secondary outcome measures: Weight records over time provided intra-patient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis).Results: By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation.Conclusions: Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor

Original language	English
Article number	e010836
Pages (from-to)	1-14
Number of pages	14
Journal	BMJ Open
Volume	6
Issue number	7
Early online date	26 Jul 2016
DOIs	https://doi.org/10.1136/bmjopen-2015-010836
Publication status	Published - Jul 2016

Bibliographical note

Acknowledgements The authors would like to thank the Scottish Diabetes Research Network Epidemiology Group for granting permission to use this database. They also thank the data management team in the University of Aberdeen who were the initial conduit for access to these data and also provided validation to the various data cleaning criteria applied. Jeremy
J Walker, University of Edinburgh, was invaluable for the original funding application and initial exploration of data. HSRU is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Funding Chief Scientist Office (CSO) reference number: CZG/2/571.

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Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study
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Lorna Aucott
Person: Academic Related - Research
Alison Avenell
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Clinical Chair in Health Services Research
- Institute of Applied Health Sciences
Person: Clinical Academic

Cite this

Aucott, L. S., Philip, S., Avenell, A., Afolabi, E. K., Sattar, N., Wild, S., & Scottish Diabetes Research Network (SDRN) Epidemiology group (2016). Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study. BMJ Open, 6(7), 1-14. Article e010836. https://doi.org/10.1136/bmjopen-2015-010836

Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study. / Aucott, Lorna S. (Corresponding Author); Philip, Sam; Avenell, Alison et al.
In: BMJ Open, Vol. 6, No. 7, e010836, 07.2016, p. 1-14.

Research output: Contribution to journal › Article › peer-review

Aucott, LS, Philip, S, Avenell, A, Afolabi, EK, Sattar, N, Wild, S & Scottish Diabetes Research Network (SDRN) Epidemiology group 2016, 'Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study', BMJ Open, vol. 6, no. 7, e010836, pp. 1-14. https://doi.org/10.1136/bmjopen-2015-010836

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abstract = "Objectives: To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes.Setting: Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records.Participants: 29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years. Primary and secondary outcome measures: Weight records over time provided intra-patient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis).Results: By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation.Conclusions: Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor",

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note = "Acknowledgements The authors would like to thank the Scottish Diabetes Research Network Epidemiology Group for granting permission to use this database. They also thank the data management team in the University of Aberdeen who were the initial conduit for access to these data and also provided validation to the various data cleaning criteria applied. Jeremy J Walker, University of Edinburgh, was invaluable for the original funding application and initial exploration of data. HSRU is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Funding Chief Scientist Office (CSO) reference number: CZG/2/571.",

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T1 - Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes

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AU - Philip, Sam

AU - Avenell, Alison

AU - Afolabi, Ebenezer Kolawole

AU - Sattar, Naveed

AU - Scottish Diabetes Research Network (SDRN) Epidemiology group

A2 - Wild, Sarah

N1 - Acknowledgements The authors would like to thank the Scottish Diabetes Research Network Epidemiology Group for granting permission to use this database. They also thank the data management team in the University of Aberdeen who were the initial conduit for access to these data and also provided validation to the various data cleaning criteria applied. Jeremy J Walker, University of Edinburgh, was invaluable for the original funding application and initial exploration of data. HSRU is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Funding Chief Scientist Office (CSO) reference number: CZG/2/571.

PY - 2016/7

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N2 - Objectives: To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes.Setting: Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records.Participants: 29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years. Primary and secondary outcome measures: Weight records over time provided intra-patient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis).Results: By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation.Conclusions: Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor

AB - Objectives: To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes.Setting: Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records.Participants: 29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years. Primary and secondary outcome measures: Weight records over time provided intra-patient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis).Results: By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation.Conclusions: Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor

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DO - 10.1136/bmjopen-2015-010836

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Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study

Abstract

Bibliographical note

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Lorna Aucott

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