By Colin Kenny, GP, Dromore
A cohort of 155,917 people with type 2 diabetes who were started on insulin therapy and continued on the treatment for at least 6 months was selected from a large US database of electronic medical records. Longitudinal changes were estimated in body weight and HbA1c by BMI category. Individuals had a mean age of 59 years, HbA1c of 80 mmol/mol (9.5%) and BMI of 35 kg/m2 at insulin initiation. The HbA1c levels at insulin initiation were significantly lower in the people who were obese than in those with normal body weight. However, the proportions of people with HbA1c >58 mmol/mol (7.5%) or >64 mmol/mol (8.0%) were similar across the BMI categories.
The adjusted weight gain progressively fell with increasing baseline BMI category over 6, 12 and 24 months. The adjusted changes in HbA1c were similar across BMI categories. A 1% (10.9 mmol/mol) decrease in HbA1c was associated with progressively less weight gain as pre-treatment BMI rose. During 24 months of insulin treatment, people who were obese gained significantly less body weight than did normal-weight or overweight individuals, while achieving clinically similar glycaemic benefits.
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