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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.

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cam.issuedOnline2021-12-02
dc.contributor.authorStrelitz, Jean
dc.contributor.authorLawlor, Emma R
dc.contributor.authorWu, Yue
dc.contributor.authorEstlin, Annabel
dc.contributor.authorNandakumar, Giri
dc.contributor.authorAhern, Amy L
dc.contributor.authorGriffin, Simon J
dc.contributor.orcidStrelitz, Jean [0000-0003-4051-6944]
dc.contributor.orcidLawlor, Emma R [0000-0002-0742-0476]
dc.contributor.orcidAhern, Amy L [0000-0001-5069-4758]
dc.contributor.orcidGriffin, Simon J [0000-0002-2157-4797]
dc.date.accessioned2022-01-31T16:21:14Z
dc.date.available2022-01-31T16:21:14Z
dc.date.issued2022-03
dc.date.submitted2021-05-26
dc.date.updated2022-01-31T16:21:13Z
dc.description.abstractAIMS/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.
dc.description.sponsorshipMRC Epidemiology Unit core funding MC_UU_12015/4 and NIHR PGfAR RP PG 0216 20010
dc.identifier.doi10.17863/CAM.80893
dc.identifier.eissn1432-0428
dc.identifier.issn0012-186X
dc.identifier.others00125-021-05605-1
dc.identifier.other5605
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/333472
dc.languageen
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.publisher.urlhttp://dx.doi.org/10.1007/s00125-021-05605-1
dc.subjectCardiovascular complications
dc.subjectCardiovascular disease
dc.subjectEpidemiology
dc.subjectMeta-analysis
dc.subjectSystematic review
dc.subjectType 2 diabetes
dc.subjectWeight change
dc.subjectWeight loss
dc.subjectWeight management
dc.subjectAdult
dc.subjectCardiovascular Diseases
dc.subjectDiabetes Mellitus, Type 2
dc.subjectHumans
dc.subjectIncidence
dc.subjectObservational Studies as Topic
dc.subjectWeight Gain
dc.subjectWeight Loss
dc.titleAssociation 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.
dc.typeArticle
dcterms.dateAccepted2021-08-25
prism.endingPage439
prism.issueIdentifier3
prism.publicationNameDiabetologia
prism.startingPage424
prism.volume65
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (RP-PG-0216-20010)
pubs.funder-project-idMedical Research Council (MC_UU_12015/4)
pubs.funder-project-idMRC (MC_UU_00006/6)
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1007/s00125-021-05605-1

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