Weight Change and Glycemic Control in a Population-based Sample of Adults with Older-onset Diabetes

Background: Numerous clinic-based studies have observed improved glycemic control with even moderate weight reductions, for periods up to 1 year, in obese subjects with noninsulin-dependent diabetes mellitus (NIDDM). Similar benefits of weight loss have not been well documented in free-living populations, particularly in older persons with NIDDM of long duration.

Methods: Relations between weight change and glycosylated hemoglobin were evaluated in a population-based sample of persons with older-onset diabetes. Persons participating in baseline (1980-1982, n = 1370) and two follow-up examinations (1984-1986, n = 987; 1990-1992, n = 550) were included. Mean glycosylated hemoglobin levels among those losing, gaining, or remaining within 5 kg were compared in all subjects combined and stratified by insulin use, using ordinary least-squares regression to adjust for confounding variables.

Results: Subjects who lost weight had higher mean glycosylated hemoglobin compared to those who gained weight (baseline to second exam only). This pattern remained in those not using insulin. Weight change was not related to glycosylated hemoglobin in persons using insulin.

Conclusions: Associations suggest that in older persons not using insulin, moderate weight loss over periods of 4-6 years has little beneficial impact on glycosylated hemoglobin. Weight loss may be reflecting disease processes that also result in poor glycemic control. Intentional weight loss achieved over a shorter time period and maintained through the later years in older diabetic persons remains to be evaluated.