Which Diabetes Patients Would Most Benefit from Weight Loss Interventions?
Hemoglobin A1c and health can distinguish between patients with type 2 diabetes who would benefit from weight loss interventions for cardiovascular health, according to according to a recent study.
The researchers conducted a post-hoc analysis using data from the Action for Health and Diabetes randomized controlled trial that included 5145 patients with type 2 diabetes, of whom 4901 were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases. From the 4901, researchers divide the participants into a training set (n=2450) and a testing data (n=2451).
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Analyses showed that baseline self-reported general health and HbA1c distinguished participants who would benefit differently from the intervention.
Cox models showed that the number needed to treat to prevent 1 cardiovascular event was 28.9 person over 9.6 years among those with HbA1c of 6.8% or greater, and among participants with HbA1c below 6.8% and with a Short Form Health Survey (SF-36) general health score of 48 or more.
Conversely, participants who had a SF-36 general health score below 48 and HbA1c below 6.8% had an absolute risk increase of 7.41% for a cardiovascular event.
“Look AHEAD participants with moderately or poorly controlled diabetes (HbA1c 6·8% or higher) and subjects with well controlled diabetes (HbA1c less than 6·8%) and good self-reported health (85% of the overall study population) averted cardiovascular events from a behavioral intervention aimed at weight loss,” the researchers concluded. “However, 15% of participants with well controlled diabetes and poor self-reported general health experienced negative effects that rendered the overall study outcome neutral.”
“HbA1c and a short questionnaire on general health might identify people with type 2 diabetes likely to derive benefit from an intensive lifestyle intervention aimed at weight loss.”
—Melissa Weiss
Reference:
Baum A, Scarpa J, Bruzelius E, Tamler R, Basu S, Faghmous J. Targeting weight loss interventions to reduce cardiovascular complications of type 2 diabetes: a machine learning-based post-hoc analysis of heterogeneous treatment effects in the Look AHEAD trial [published online July 12, 2017]. Lancet Diabetes Endocrinol. http://dx.doi.org/10.1016/S2213-8587(17)30176-6.