Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 53, Issue 1 M27-M32, Copyright © 1998 by The Gerontological Society of America
Weight change and glycemic control in a population-based sample of adults with older-onset diabetes
SM Shoff, R Klein, SE Moss, BE Klein and KJ Cruickshanks
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, USA.
BACKGROUND: Numerous clinic-based studies have observed improved glycemic
control with even moderate weight reductions, for periods up to 1 year, in
obese subjects with noninsulin-dependent diabetes mellitus (NIDDM). Similar
benefits of weight loss have not been well documented in free-living
populations, particularly in older persons with NIDDM of long duration.
METHODS: Relations between weight change and glycosylated hemoglobin were
evaluated in a population-based sample of persons with older-onset
diabetes. Persons participating in baseline (1980-1982, n = 1370) and two
follow-up examinations (1984-1986, n = 987; 1990-1992, n = 550) were
included. Mean glycosylated hemoglobin levels among those losing, gaining,
or remaining within 5 kg were compared in all subjects combined and
stratified by insulin use, using ordinary least-squares regression to
adjust for confounding variables. RESULTS: Subjects who lost weight had
higher mean glycosylated hemoglobin compared to those who gained weight
(baseline to second exam only). This pattern remained in those not using
insulin. Weight change was not related to glycosylated hemoglobin in
persons using insulin. CONCLUSIONS: Associations suggest that in older
persons not using insulin, moderate weight loss over periods of 4-6 years
has little beneficial impact on glycosylated hemoglobin. Weight loss may be
reflecting disease processes that also result in poor glycemic control.
Intentional weight loss achieved over a shorter time period and maintained
through the later years in older diabetic persons remains to be evaluated.
