Assessing diabetes risk could optimize effectiveness of weight loss therapy
medwireNews: Targeting obese patients for weight-loss therapy according to their cardiometabolic status could much improve its effectiveness for diabetes prevention, say researchers.
Fangjian Guo (University of Texas Medical Branch, Galveston, USA) and W Timothy Garvey (The University of Alabama at Birmingham, USA) used the Cardiometabolic Disease Staging (CMDS) system to categorise 3040 overweight or obese patients from three randomized trials of phentermine/topiramate extended release according to their risk for developing diabetes.
The CMDS is based simply on the components of the metabolic syndrome, so is easy to use in clinical practice, notes the team in Diabetes Care. “Thus, CMDS is an effective and practical tool for stratifying diabetes risk to enhance and inform clinical decisions regarding the intensity and modality of obesity treatment.”
The 1-year rates of new-onset diabetes among the placebo-treated patients were 1.51%, 4.67%, and 10.43% for those with low, moderate, and high CMDS risk, respectively. And the corresponding relative risk reductions produced by active treatment were 95%, 81%, and 41%.
Guo and Garvey suggest that higher-risk patients may be more prone to developing diabetes even in the event of weight loss, noting that this occurs in around 20% of patients, resulting in smaller relative risk reductions than those achieved in low-risk patients.
“Even so, from a population perspective, weight-loss therapy was more effective in reducing absolute rates of incident [type 2 diabetes] in the high-risk subgroup of overweight or obese patients,” they note.
The absolute diabetes rates among patients who received active treatment were 0.67%, 2.37%, and 6.29% for the low-, moderate-, and high-risk patients, respectively, giving absolute risk reductions of 0.84%, 2.30%, and 4.14%. This gave corresponding numbers needed to treat to prevent one case of diabetes of 120, 43, and 24, meaning treatment was much more effective in the high-risk category.
The researchers also note that the differences between the groups would be expected to widen over time, because the incidence of diabetes would rise faster in the placebo group versus the treated group, further increasing the effectiveness of treatment in the high-risk versus the low-risk categories with longer duration.
“The targeting of higher-risk patients for more intensive weight-loss therapy will optimize the benefit/risk ratio of these interventions and help promote rational patterns of medical therapy and health care policy for obesity,” conclude Guo and Garvey, adding that it could also have a positive effect on cost effectiveness.
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