Researchers determine three pathways for body mass index of people living with type 2 diabetes
Study finds link between related complications, diabetes medication and use of healthcare services.
A decade-long study by researchers in Finland has developed new understanding about long-term direction of the body mass index (BMI) of people living with type 2 diabetes.
The findings of the study by researchers at the University of Eastern Finland were recently published in Diabetes Research and Clinical Practice.
The study included 3,539 adults living in North Karelia, Finland, who were diagnosed with type 2 diabetes between 2011 and 2014. The figures were based on electronic health records, which were used to examine BMI trajectories over the ten years following diagnosis.
In this decade-long follow-up period, the BMI trajectories were linked with significant differences in related complications, diabetes medication and healthcare service use.
Researchers identified three distinct BMI trajectories. Of the people with type 2 diabetes, 77.7% had a stable BMI trajectory, 14.6% had an increasing BMI trajectory and 7.7% had a decreasing BMI trajectory. Among those with an increasing BMI trajectory, BMI rose steadily during the follow-up, whereas among those with a decreasing BMI trajectory, BMI was high at baseline but decreased over the follow-up period to a level close to that seen in those with a stable trajectory.
Increased BMI was linked to additional related health complications
During the follow-up, those with an increasing BMI trajectory had more chronic kidney and urinary tract diseases, sleep disorders, sleep apnoea and chronic respiratory diseases than those with other BMI trajectories. The use of diabetes medications that support weight management also became more common during the follow-up, particularly among people with an increasing BMI trajectory.
Suvi Koivunen, University Lecturer, and lead study author, said: “The findings show that people with type 2 diabetes do not form a homogeneous group. Based on BMI trajectories, it is possible to identify individuals who may have an increased risk of developing comorbidities and requiring more care.”
Weight loss does not always mean better health
People with a decreasing BMI trajectory differed from those with the other BMI trajectories in that they had higher healthcare service use and higher mortality.
They also had higher cases of memory disorders in addition to cardiovascular and pulmonary diseases than those with the other weight patterns.
Researchers said that weight loss could be due to several factors, including successful weight management; however, it could also be related to diseases, ageing and frailty. According to the researchers, the register-based data did not allow the reasons for weight loss to be determined with sufficient confidence.
Ms Koivunen said: “Weight changes should be considered as part of the patient’s overall situation. Particularly in older patients and those with multimorbidity, it is important to carefully assess the underlying causes of weight changes.”
Comprehensive diabetes care should consider impact of weight changes
The study findings highlighted the importance of long-term monitoring in type 2 diabetes.
The findings also highlight the importance of weight management as part of comprehensive type 2 diabetes care, alongside other forms of treatment.
According to the researchers, the findings could support the development of individualised care pathways and the planning for long-term management of type 2 diabetes.
The study concluded: “These findings reveal considerable heterogeneity in long-term outcomes among people with type 2 diabetes and highlight the need for continuous monitoring and targeted support to maintain metabolic control and manage comorbidity burden.”
Read the report in Diabetes Research and Clinical Practice
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