Feldstein Adrianne C, Nichols Gregory A, Smith David H, Stevens Victor J, Bachman Keith, Rosales A Gabriela, Perrin Nancy
1Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
Diabetes Care. 2008 Oct;31(10):1960-5. doi: 10.2337/dc08-0426. Epub 2008 Jun 20.
Weight loss in type 2 diabetes is undisputedly important, and data from community settings are limited. We evaluated weight change and resulting glycemic and blood pressure control in type 2 diabetic patients at an HMO.
Using electronic medical records, this retrospective cohort study identified 2,574 patients aged 21-75 years who received a new diagnosis of type 2 diabetes between 1997 and 2002. We estimated 3-year weight trajectories using growth curve analyses, grouped similar trajectories into four categories using cluster analysis, compared category characteristics, and predicted year-4 above-goal A1C and blood pressure by group.
The weight-trajectory groups were defined as higher stable weight (n = 418; 16.2%), lower stable weight (n = 1,542; 59.9%), weight gain (n = 300; 11.7%), and weight loss (n = 314; 12.2%). The latter had a mean weight loss of 10.7 kg (-9.8%; P < 0.001) by 18 months, with near-complete regain by 36 months. After adjusting for age, sex, baseline control, and related medication use, those with higher stable weight, lower stable weight, or weight-gain patterns were more likely than those who lost weight to have above-goal A1C (odds ratio [OR] 1.66 [95% CI 1.12-2.47], 1.52 [1.08-2.14], and 1.77 [1.15-2.72], respectively). Those with higher stable weight or weight-gain patterns were more likely than those who lost weight to have above-goal blood pressure (1.83 [1.31-2.57] and 1.47 [1.03-2.10], respectively).
A weight-loss pattern after new diagnosis of type 2 diabetes predicted improved glycemic and blood pressure control despite weight regain. The initial period postdiagnosis may be a critical time to apply weight-loss treatments to improve risk factor control.
2型糖尿病患者体重减轻无疑非常重要，而来自社区环境的数据有限。我们评估了一家健康维护组织（HMO）中2型糖尿病患者的体重变化以及由此带来的血糖和血压控制情况。
利用电子病历，这项回顾性队列研究确定了1997年至2002年间新诊断为2型糖尿病的2574名年龄在21 - 75岁之间的患者。我们使用生长曲线分析估计了3年的体重轨迹，通过聚类分析将相似的轨迹分为四类，比较了类别特征，并按组预测了第4年高于目标的糖化血红蛋白（A1C）和血压。
体重轨迹组被定义为较高稳定体重组（n = 418；16.2%）、较低稳定体重组（n = 1542；59.9%）、体重增加组（n = 300；11.7%）和体重减轻组（n = 314；12.2%）。体重减轻组在18个月时平均体重减轻10.7千克（-9.8%；P < 0.001），到36个月时几乎完全恢复。在调整年龄、性别、基线控制和相关药物使用情况后，与体重减轻的患者相比，较高稳定体重组、较低稳定体重组或体重增加模式的患者更有可能出现高于目标的糖化血红蛋白（比值比[OR]分别为1.66[95%可信区间1.12 - 2.47]、1.52[1.08 - 2.14]和1.77[1.15 - 2.72]）。与体重减轻的患者相比，较高稳定体重组或体重增加模式的患者更有可能出现高于目标的血压（分别为1.83[1.31 - 2.57]和1.47[1.03 - 2.10]）。
2型糖尿病新诊断后的体重减轻模式预示着尽管体重会恢复，但血糖和血压控制会得到改善。诊断后的初始阶段可能是应用体重减轻治疗以改善危险因素控制的关键时期。
