Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

Katsoulis, M. et al | 2021 | Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records | The Lancet Diabetes & Endocrinology | https://doi.org/10.1016/S2213-8587(21)00207-2

The researchers behind this paper use electronic health records of over 2 million people to address four research objectives:

(1) to test the extent to which temporal trends in mean BMI changes between 1998 and 2016 are replicated between EHRs and survey methods

 (2) to compare the extent and distribution of BMI changes across age groups and BMI categories

(3) to estimate the associations between age, sex, degree of social deprivation, ethnicity, and geographical region with transitions across BMI categories

(4) to produce a risk calculator (both online and in chart-form), showing how these risk factors combine to identify groups at a high risk of transitioning to higher BMI categories.

Their findings show that young adults (aged 18–24 years) had a markedly greater risk for transitioning to higher BMI categories than did older age groups (ie, those aged 65–74 years). Compared with age, the researchers found smaller additional contributions to the risk of BMI change, including being male, living in socially deprived neighbourhoods, and being from a Black ethnic background. . The authors provide the first estimates of the risks of transitioning between underweight, normal weight, overweight, and obesity BMI categories at 1, 5, and 10 years (risk charts and an online tool). They also show the value of using longitudinal population-based EHRs to identify and monitor specific population groups at risk of weight gain (Source: Katsoulis et al, 2021).

Summary

Background

Targeted obesity prevention policies would benefit from the identification of population groups with the highest risk of weight gain. The relative importance of adult age, sex, ethnicity, geographical region, and degree of social deprivation on weight gain is not known. We aimed to identify high-risk groups for changes in weight and BMI using electronic health records (EHR).

Methods

In this longitudinal, population-based cohort study we used linked EHR data from 400 primary care practices (via the Clinical Practice Research Datalink) in England, accessed via the CALIBER programme. Eligible participants were aged 18–74 years, were registered at a general practice clinic, and had BMI and weight measurements recorded between Jan 1, 1998, and June 30, 2016, during the period when they had eligible linked data with at least 1 year of follow-up time. We calculated longitudinal changes in BMI over 1, 5, and 10 years, and investigated the absolute risk and odds ratios (ORs) of transitioning between BMI categories (underweight, normal weight, overweight, obesity class 1 and 2, and severe obesity [class 3]), as defined by WHO. The associations of demographic factors with BMI transitions were estimated by use of logistic regression analysis, adjusting for baseline BMI, family history of cardiovascular disease, use of diuretics, and prevalent chronic conditions.

Findings

We included 2 092 260 eligible individuals with more than 9 million BMI measurements in our study. Young adult age was the strongest risk factor for weight gain at 1, 5, and 10 years of follow-up. Compared with the oldest age group (65–74 years), adults in the youngest age group (18–24 years) had the highest OR (4·22 [95 per cent  CI 3·86–4·62]) and greatest absolute risk (37 per cent vs 24 per cent ) of transitioning from normal weight to overweight or obesity at 10 years. Likewise, adults in the youngest age group with overweight or obesity at baseline were also at highest risk to transition to a higher BMI category; OR 4·60 (4·06–5·22) and absolute risk (42 per cent  vs 18 per cent ) of transitioning from overweight to class 1 and 2 obesity, and OR 5·87 (5·23–6·59) and absolute risk (22 per cent  vs 5 per cent ) of transitioning from class 1 and 2 obesity to class 3 obesity. Other demographic factors were consistently less strongly associated with these transitions; for example, the OR of transitioning from normal weight to overweight or obesity in people living in the most socially deprived versus least deprived areas was 1·23 (1·18–1·27), for men versus women was 1·12 (1·08–1·16), and for Black individuals versus White individuals was 1·13 (1·04–1·24). We provide an open access online risk calculator, and present high-resolution obesity risk charts over a 1-year, 5-year, and 10-year follow-up period.

Interpretation

A radical shift in policy is required to focus on individuals at the highest risk of weight gain (ie, young adults aged 18–24 years) for individual-level and population-level prevention of obesity and its long-term consequences for health and health care.

Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

DiRECT trial: New findings that suggest that losing weight and being in remission from TD can improve heart health

Diabetes UK | April  2021 | DUKPC research highlights: day 2

At this year’s Diabetes UK Professional Conference (DUKPC), Professor Roy Taylor, from the University of Newcastle discussed his latest findings from the DiRECT trial. Funded by Diabetes UK, the DiRECT trial ( Diabetes Remission Clinical Trial) has been led by Professor Taylor and his colleagues for the last decade. At this year’s online conference Prof Taylor shared new findings that indicate weight loss and going into remission could reduce the risk of heart disease.

29 participants with type 2 diabetes from the trial were analysed to explore how losing weight and going into remission affects risk of heart disease. The researcher used a risk calculator, which combines information on a range of different factors linked with heart disease to predict the risk of having a heart attack or stroke. 

Image source: Diabetes UK Description: Visual summary of the latest DiRECT findings

Six months later, all the participants experienced a reduction in weight and had less internal body fat, and this lowered their risk of heart disease. But the reduction in risk was most pronounced for people who had put their type 2 diabetes in remission compared to those who were not in remission. This gives us early evidence that being in remission could help to protect against heart attacks and strokes later in life. The findings also show that weight loss on its own can benefit health, even if you don’t go into remission.  

This research is really encouraging and builds a picture of how remission can offer people with type 2 diabetes a chance of a better quality of life, without the complications of diabetes. But there’s still more we need to find out about how much remission can protect people against diabetes complications. That’s why it’s important to keep on getting regular health checks even when you are in remission to make sure that any new, or existing complications, can be monitored and treated.  (Source: Diabetes UK)

Full details are available from Diabetes UK

See also: Newcastle University Reversing Type 2 Diabetes and ongoing remission

BMJ: Losing weight following diagnosis of type 2 diabetes boosts chance of remission

BMJ | February 2020 | Losing weight following diagnosis of type 2 diabetes boosts chance of remission

Previous studies have shown that remission of type 2 diabetes, without medication or surgery, is achievable through intensive low calorie diets and behaviour change in those who have lived with diabetes for some years. Many of these studies have also been relatively short. A new feature in the BMJ highlights the findings of  recent study (published last year) that  looks at patients newly diagnosed with diabetes aged between 40–69 years from the ADDITION‐Cambridge trial.

BMJ Losing weight following diagnosis of type 2 diabetes boosts chance of remission

Why was this study needed?

 

Around one in 10 adults over 40 in the UK has been diagnosed with type 2 diabetes. This has been fuelled by the rise in rates of obesity. Diabetes UK estimates that in addition to the 3.8 million adults who have been diagnosed with type 2 diabetes, a further one million have the disease without knowing it. Diabetes and its complications, including kidney failure, loss of sight, and lower limb amputations, cost the NHS £6 billion every year.

Previous studies have shown that remission of type 2 diabetes, without medication or surgery, is achievable through intensive low calorie diets and behaviour change in those who have lived with diabetes for some years. Many of these studies have also been relatively short.

The present study looked at whether a more moderate approach could achieve remission over the longer term, and whether a window of opportunity exists following diagnosis when weight loss interventions may be both effective and acceptable.

 

What did this study do?

This was a prospective cohort study of 867 people, aged 40 to 69, who were newly diagnosed with diabetes. Participants had been enrolled in the ADDITION-Cambridge randomised controlled trial, from 49 GP practices in the east of England between 2002 and 2006. The trial randomised participants into an intervention group, who received additional support, or the control “usual care” group. This cohort study pooled data from both groups to look at who achieved remission during five years of follow-up.

Participants’ weight, physical activity, diet, and alcohol consumption at baseline and one year were assessed. At five year follow-up, 730 people (84%) had weight and HbA1c measures taken. The participants were predominantly white.

 

What did it find?

● Diabetes remission, defined as an HbA1c level of less than 48 mmol/mol (6.5%) in the absence of any diabetes medication or bariatric surgery, was achieved in 257 participants (30%) at five year follow-up.

● People who lost at least 10% of their body weight in the first year after diagnosis of diabetes were more likely to achieve remission at five years compared with those with stable or increased weight.

● Similar trends were observed in those who had more modest weight loss of 5% to 10% over the first year after diagnosis, but this was not statistically significant.

● In the subsequent four years (ie, between the end of the first year and the end of the five year study), achieving at least a 10% weight loss was associated with more than double the chance of remission at five year follow-up.

● In this period weight loss of 5% to 10% was also associated with an increased likelihood of remission.

 

 

NIHR Signal Losing weight following type 2 diabetes diagnosis boosts chance of remission

Signal available from BMJ

Full reference: Dambha-Miller H, Day AJ, Strelitz J, et al. Behaviour change, weight loss and remission of Type 2 diabetes: a community-based prospective cohort study. Diabet Med 2019. doi:10.1111/dme.14122.

Abstract

Aim

To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5‐year follow‐up.

Method

We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40–69 years from the ADDITION‐Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self‐report), and alcohol consumption (self‐report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1–5 years, as well as remission at 5‐year follow‐up.

Results

Diabetes remission was achieved in 257 participants (30%) at 5‐year follow‐up. Compared with people who maintained the same weight, those who achieved more than or equal to 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission. In the subsequent 1–5 years, achieving more than or equal to 10% weight loss was also associated with remission.

Conclusion

In a population‐based sample of adults with screen‐detected Type 2 diabetes, weight loss of more than or equal to 10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

What’s new?

  • Biochemical remission of Type 2 diabetes in the absence of pharmacological or surgical intervention has been shown to be achievable.
  • This has been previously demonstrated in short‐term studies and only in selected populations through intensive weight loss programmes.
  • We found that weight loss of ≥10% in the first few years after diagnosis was strongly associated with remission of Type 2 diabetes at 5 years.
  • This was achieved without intensive lifestyle interventions or extreme calorie restrictions.
  • Our findings should inform discussions with people who have newly diagnosed Type 2 diabetes as a motivation towards remission of the disease without restrictive and sometimes unachievable calorie restrictions.

Study available from Diabetic Medicine

Losing weight following type 2 diabetes diagnosis boosts chance of remission

People who lose at least 10% of their body weight in the first year after being diagnosed with type 2 diabetes increase their chances of being in remission after five years, compared with those whose weight remains stable. Losing this achievable amount of weight over the next four years also makes remission more likely | Via National Institute for Health Research 

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In this study of 867 people, 257 (30%) achieved remission at five-year follow-up. The participants had been taking part in a trial but had not received intensive lifestyle interventions or been put on extremely calorie-restricted diets.

This NIHR-funded study strengthens the evidence that healthy behaviour change and weight loss can result in remission of type 2 diabetes. This finding may help to motivate people to lose weight soon after a diabetes diagnosis ─ setting realistic and achievable targets can make a difference in the longer term.

Further detail at National Institute for Health research

Full reference: Dambha‐Miller H, Day AJ, Strelitz J et al. | Behaviour change, weight loss and remission of Type 2 diabetes: a community‐based prospective cohort study | Diabetic Medicine

Type 2 diabetes can be reversed with a modest weight loss of 10% or more

NIHR | September 2019 | Type 2 diabetes can be reversed with a modest weight loss of 10% or more

New research led by researchers at the University of Cambridge reports that individuals with a diagnosis of type 2 diabetes who reduced their  weight by one-tenth or more, were able to see their condition go into remission.

kitchen-2608932_640.jpg

The study followed a cohort (n=867) over time; and found that 257 participants (30%) participants were in remission at five-year follow-up. People who achieved weight loss of 10% or more within the first five years after diagnosis were more than twice as likely to go into remission compared to people who maintained the same weight. The participants in the study who achieved remission did so without intensive lifestyle interventions or extreme calorie restrictions.

“We’ve known for some time now that it’s possible to send diabetes into remission using fairly drastic measures such as intensive weight loss programmes and extreme calorie restriction,” says Dr Hajira Dambha-Miller from the Department of Public Health and Primary Care.

In order to clarify the best way to help patients with type 2 diabetes achieve sustained weight loss, the research team is currently undertaking a study called GLoW (Glucose Lowering through Weight management). The study compares the current education programme offered by the NHS to people after they have been diagnosed, with a programme delivered by WW (formerly Weight Watchers®) (Source NIHR & University of Cambridge)

Read the press release from NIHR 

See also: University of Cambridge Type 2 diabetes remission possible with ‘achievable’ weight loss, say researchers

 

Abstract

Aim

To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5‐year follow‐up.

 

Method

We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40–69 years from the ADDITION‐Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self‐report), and alcohol consumption (self‐report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA1c level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1–5 years, as well as remission at 5‐year follow‐up.

 

Results

Diabetes remission was achieved in 257 participants (30%) at 5‐year follow‐up. Compared with people who maintained the same weight, those who achieved more than or equal to 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission. In the subsequent 1–5 years, achieving more than or equal to 10% weight loss was also associated with remission.

 

Conclusion

In a population‐based sample of adults with screen‐detected Type 2 diabetes, weight loss of more than or equal to 10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.

Full reference: Dambha-Miller, H et al | 2019|  Behaviour change, weight loss and remission of type 2 diabetes: a community based prospective cohort study|Diabetic Medicine| DOI: 10.1111/dme.14122 

The article is available in full from Diabetic Medicine

Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial

Lean, M. E. et al |2019| Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial| The Lancet Diabetes & Endocrinology.

scale-diet-fat-health-53404.jpegSummary

Background

The DiRECT trial assessed remission of type 2 diabetes during a primary care-led weight-management programme. At 1 year, 68 (46%) of 149 intervention participants were in remission and 36 (24%) had achieved at least 15 kg weight loss. The aim of this 2-year analysis is to assess the durability of the intervention effect.

Methods

DiRECT is an open-label, cluster-randomised, controlled trial done at primary care practices in the UK. Practices were randomly assigned (1:1) via a computer-generated list to provide an integrated structured weight-management programme (intervention) or best-practice care in accordance with guidelines (control), with stratification for study site (Tyneside or Scotland) and practice list size (more than 5700 or more than or equal to5700 people). Allocation was concealed from the study statisticians; participants, carers, and study research assistants were aware of allocation. We recruited individuals aged 20–65 years, with less than 6 years’ duration of type 2 diabetes, BMI 27–45 kg/m 2, and not receiving insulin between July 25, 2014, and Aug 5, 2016. The intervention consisted of withdrawal of antidiabetes and antihypertensive drugs, total diet replacement (825–853 kcal per day formula diet for 12–20 weeks), stepped food reintroduction (2–8 weeks), and then structured support for weight-loss maintenance. The coprimary outcomes, analysed hierarchically in the intention-to-treat population at 24 months, were weight loss of at least 15 kg, and remission of diabetes, defined as HbA 1c less than 6·5% (48 mmol/mol) after withdrawal of antidiabetes drugs at baseline (remission was determined independently at 12 and 24 months). The trial is registered with the ISRCTN registry, number 03267836, and follow-up is ongoing.

Findings

The intention-to-treat population consisted of 149 participants per group. At 24 months, 17 (11%) intervention participants and three (2%) control participants had weight loss of at least 15 kg and 53 (36%) intervention participants and five (3%) control participants had remission of diabetes. The adjusted mean difference between the control and intervention groups in change in bodyweight was −5·4 kg and in HbA 1c was −4·8 mmol/mol, despite only 51 (40%) of 129 patients in the intervention group using anti-diabetes medication compared with 120 (84%) of 143 in the control group. In a post-hoc analysis of the whole study population, of those participants who maintained at least 10 kg weight loss (45 of 272 with data), 29 (64%) achieved remission; 36 (24%) of 149 participants in the intervention group maintained at least 10 kg weight loss. Serious adverse events were similar to those reported at 12 months, but were fewer in the intervention group than in the control group in the second year of the study (nine vs 22).

Interpretation

The DiRECT programme sustained remissions at 24 months for more than a third of people with type 2 diabetes. Sustained remission was linked to the extent of sustained weight loss.

The Library & Knowledge Service can provide access to this article for Rotherham NHS Staff, request a copy here 

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