medwireNews: Losing weight is the most impactful thing people with type 2 diabetes can do to counteract the life-shortening effects of their condition, say researchers.
The results come from a modeling study that assessed the effects of changes in BMI, glycemic control, blood pressure, and lipid levels on the life expectancy of people with type 2 diabetes.
Presenting the findings at the virtual ADA 81st Scientific Sessions, Hui Shao (University of Florida College of Pharmacy, Gainesville, USA) revealed that people who moved from a BMI of 41.4 kg/m2 to one of 24.3 kg/m2 would regain an average of nearly 4 life–years.
He conceded, however, that this is “not an easy task,” and also noted that weight loss is notoriously difficult to maintain.
“Nevertheless, remember that all the interventions that target bodyweight reduction are also likely to reduce [glycated hemoglobin], reduce the blood pressure, reduce the lipids,” said the presenter.
“So that’s why we believe that the benefit of BMI control is actually larger than we estimated – because here we only estimated the additional life–years exclusively associated with BMI control – and thus we believe that bodyweight reduction among persons 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 using data from the US NHANES 2009–2010, and used 2015–2016 data for the simulation.
Moving from a BMI of 41.4 to 24.3 kg/m2 represented a move from the average BMI of the fourth quartile to that of the first quartile, based on the 2015–2016 data. Moving from the fourth to third (33.0 kg/m2) quartile was associated with an additional 2 life–years and from the fourth to second (28.6 kg/m2) with nearly 3 additional life–years.
A change from the fourth (9.9%; 85 mmol/mol) to the third (7.7%; 61 mmol/mol) quartiles of glycated hemoglobin (HbA1c) levels was associated with the addition of approximately 3.4 life–years. Moving from the fourth to the second (6.8%; 51 mmol/mol) and first (5.9%; 41 mmol/mol) quartiles was associated with approximately 3.7–3.8 additional life–years, but Shao noted that the benefits reduced as HbA1c became closer to normal.
This therefore supports an HbA1c target of around 7%, he said.
However, he noted that the BRAVO model is based on data from ACCORD, in which participants given the most intensive treatment had an increased mortality risk. But he suggested that a lower HbA1c target may be achievable without increasing mortality risk with use of more recent diabetes medications.
Improving blood pressure and low-density lipoprotein cholesterol levels had smaller impacts, with the maximum life–years gained being a little less than 2 and 1, respectively.
However, Shao stressed that these risk factors “are not mutually exclusive, which means that their effects are additive.”
Therefore, if possible, “all four biomarker goals need to be achieved,” he said.
The presenter suggested that revealing to people with diabetes the number of life–years they could lose or gain according to changes in these risk factors might act as “a series of nudges” that could help motivate them to consistently take medication and follow lifestyle advice.
He noted, however, that the benefits of achieving these goals sharply reduced with older age; conversely, the youngest age groups would derive the greatest benefits from risk factor control.
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