Stability of body weight in type 2 diabetes: Response to Looker et al.

OBJECTIVE There is a concern that an "epidemic of obesity" is occurring in Western societies. One consequence of obesity is that type 2 diabetes may develop. Presumably, a great increase in body weight would continue in people with diabetes and may be accelerated due to pharmacological treatment. In this retrospective study, we tested the hypothesis that the weight gain in a diabetic population is greater than that in the general population. RESEARCH DESIGN AND METHODS Data were obtained from the records of 205 adult men who have attended a diabetes clinic for > or =5 years. Their weight and glycohemoglobin at the last visit were compared with the initial visit data. The subjects were categorized according to treatment modalities. The mean follow-up was 9.4 years (range 5-23). RESULTS For the group as a whole, the mean increase in body weight was 0.23 +/- 0.2 kg/year. BMI or initial age had little effect on the rate of weight gain. Treatment regimen used did have an effect on weight change. In subjects treated with insulin, with or without oral agents, body weight increased at a rate of 0.44 +/- 0.1 kg/year. In subjects treated with metformin or metformin and a sulfonylurea, there was a mean loss in weight, i.e., -0.24 +/- 0.09 kg/year, and with sulfonylureas alone weight increased by 0.42 +/- 0.2 kg/year. CONCLUSIONS The men treated with insulin alone or insulin combined with oral agents gained weight at a rate comparable with that reported for the general population, i.e., the weight gain was not extraordinary. Metformin treatment resulted in a modest loss of weight.