Is It Possible to Predict Diabetics' Weight Loss Success?

The American Diabetes Association says moderate weight loss (5% or more of initial body weight) enhances glycemic control, lipid profile, and blood pressure. Yet, some patients fail to lose this modest amount of weight with lifestyle modifications.

Obesity experts have identified gender, previous dieting history, starting weight, level of motivation, self-efficacy, self-esteem, and exercise as predictive factors of weight loss. Previous research has addressed the applicability of these factors to diabetics specifically.

Recently, researchers identified 5 predictive factors for weight loss extent in overweight patients with type 2 diabetes (T2D).

The researchers enrolled T2D outpatients with a body mass index >27 kg/m² into an 8-week, very-low-calorie diet regimen. The diet consisted of 2 Glucerna-brand meal replacement products per day with 75 g of lean meat, 1 serving of skim milk, and 1 serving of vegetables (750 calories total). The study criteria excluded patients with severe psychiatric or cardiovascular disease, untreated hypothyroidism, or end-stage renal disease, or who were pregnant/lactating.

Lower fasting glucose, anxiety, higher exogenous insulin need, waist-to-hip ratio, and peripheral neuropathy predicted successful weight loss. Notably, 3 of these 5 factors are diabetes related.

Glycosuria promotes weight loss. Therefore, improved diabetes control has a paradoxical effect on weight loss through this mechanism. Anxiety reduces adherence to medication and lifestyle modifications. Insulin stimulates weight gain, and patients with high baseline insulin doses benefitted the most from insulin dose reductions during very-low-calorie dieting.

Very-low-calorie diets reduce central visceral fat preferentially, and patients with higher waist-to-hip ratios experienced greater weight loss. Diabetic neuropathy’s unpleasant effects (eg, numbness) motivated patients to control their diabetes and lose weight.

Initial weight, dieting history, self-esteem, and baseline exercise had no effect on weight loss in this diabetes-specific population. Patients who failed to lose at least 5% of their body weight had higher hemoglobin A1C and fasting glucose levels, reported pruritus more often, and had lower self-esteem than other participants.

Prescribers can predict certain overweight patients with diabetes will benefit most from a very-low-calorie diet. Low fasting glucose, anxiety, higher exogenous insulin need, waist-to-hip ratio, or peripheral neuropathy predicts more successful weight loss.

Reference

Berk KA, et al. Predictors of diet-induced weight loss in overweight adults with type 2 diabetes. PLOS One. 2016 Aug.