Association between weight change and incidence of cardiovascular disease events and mortality among adults with type 2 diabetes: a systematic review of observational studies and behavioural intervention trials.
Authors
Wu, Yue
Estlin, Annabel
Nandakumar, Giri
Publication Date
2022-03Journal Title
Diabetologia
ISSN
0012-186X
Publisher
Springer Science and Business Media LLC
Volume
65
Issue
3
Pages
424-439
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Strelitz, J., Lawlor, E. R., Wu, Y., Estlin, A., Nandakumar, G., Ahern, A. L., & Griffin, S. J. (2022). Association between weight change and incidence of cardiovascular disease events and mortality among adults with type 2 diabetes: a systematic review of observational studies and behavioural intervention trials.. Diabetologia, 65 (3), 424-439. https://doi.org/10.1007/s00125-021-05605-1
Abstract
AIMS/HYPOTHESIS: Weight loss is often recommended in the treatment of type 2 diabetes. While evidence has shown that large weight loss may lead to diabetes remission and improvement in cardiovascular risk factors, long-term impacts are unclear. We performed a systematic review of studies of weight loss and other weight changes and incidence of CVD among people with type 2 diabetes. METHODS: Observational studies of behavioural (non-surgical and non-pharmaceutical) weight changes and CVD events among adults with type 2 diabetes, and trials of behavioural interventions targeting weight loss, were identified through searches of MEDLINE, EMBASE, Web of Science, CINAHL, and The Cochrane Library (CENTRAL) until 9 July 2019. Included studies reported change in weight and CVD and/or mortality outcomes among adults with type 2 diabetes. We performed a narrative synthesis of observational studies and meta-analysis of trial data. RESULTS: Of 13,227 identified articles, 17 (14 observational studies, three trials) met inclusion criteria. Weight gain (vs no change) was associated with higher hazard of CVD events (HRs [95% CIs] ranged from 1.13 [1.00, 1.29] to 1.63 [1.11, 2.39]) and all-cause mortality (HRs [95% CIs] ranged from 1.26 [1.12, 1.41] to 1.57 [1.33, 1.85]). Unintentional weight loss (vs no change) was associated with higher risks of all-cause mortality, but associations with intentional weight loss were unclear. Behavioural interventions targeting weight loss showed no effect on CVD events (pooled HR [95% CI] 0.95 [0.71, 1.27]; I2 = 50.1%). Risk of bias was moderate in most studies and was high in three studies, due to potential uncontrolled confounding and method of weight assessment. CONCLUSIONS/INTERPRETATION: Weight gain is associated with increased risks of CVD and mortality, although there is a lack of data supporting behavioural weight-loss interventions for CVD prevention among adults with type 2 diabetes. Long-term follow-up of behavioural intervention studies is needed to understand effects on CVD and mortality and to inform policy concerning weight management advice and support for people with diabetes. PROSPERO registration CRD42019127304.
Keywords
Article, Cardiovascular complications, Cardiovascular disease, Epidemiology, Meta-analysis, Systematic review, Type 2 diabetes, Weight change, Weight loss, Weight management
Sponsorship
MRC Epidemiology Unit core funding MC_UU_12015/4 and NIHR PGfAR RP PG 0216 20010
Funder references
Department of Health (via National Institute for Health Research (NIHR)) (RP-PG-0216-20010)
Medical Research Council (MC_UU_12015/4)
MRC (MC_UU_00006/6)
Identifiers
s00125-021-05605-1, 5605
External DOI: https://doi.org/10.1007/s00125-021-05605-1
This record's URL: https://www.repository.cam.ac.uk/handle/1810/333472
Rights
Licence:
http://creativecommons.org/licenses/by/4.0/
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