DM: Weight Management (2007)
What is the long-term effect (1 year or greater) of weight management on metabolic outcomes in persons with type 1 and type 2 diabetes?
In randomized clinical trials, approximately half report improvement in A1C values with weight loss; whereas, approximately half report no improvement in A1C values despite fairly similar weight losses. Eleven studies with more than 1 diet arm reported weight loss and A1C values at 12 months. Six studies in diet arms reported no improvement in A1C despite weight loss (range: -0.8 to -4.4 kg) in all but one study which reported no weight loss. Five studies in diet arms reported improvement in A1C ranging from -0.2% to -0.6% with fairly similar weight losses (range: -1.3 to -5.1 kg).
Studies using weight loss medications (orlistat and lifestyle, sibutramine) report consistent improvement in A1C. Six studies with an orlistat arm reported improvements in A1C values (range: -0.3% to -1.1%) with orlistat and lifestyle intervention with weight loss (range: -3.9 to -6.2 kg). Four studies reported improvements in A1C values (range: -0.3% to -6.0%) with sibutramine with weight loss (range: -4.1 to -8.0 kg).
Ten studies reported significant improvements in at least one lipid value, generally in triglycerides and HDL cholesterol from weight loss either by diet alone or with weight loss medications. Six studies reported improvement in blood pressure with weight loss; however, one study using sibutramine reported increases in blood pressure and one study using sibutramine reported no change in blood pressure.
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
Evidence Summary: What is the long-term effect (1 year or greater) of weight management on metabolic outcomes in persons with type 1 and type 2 diabetes?
- Quality Rating Summary
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- Ash S, Reeves MM, Yeo S, Morrison G, Carey D, Capra S. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial. International Journal of Obesity. 2003; 27:797-802.
- Berne C, for the Orlistat Swedish Type 2 Diabetes Study Group. A randomized study of orlistat in combination with a weight management programme in obese patients with Type 2 diabetes treated with metformin. Diabetic Medicine 2005;22: 612-618.
- Brinkworth GD, Noakes M, Parker B, Foster P, Clifton PM. Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomized trial. Diabetologia 2004; 47:1677-1686.
- Brown SA, Upchurch S, Anding R, Winter M, Ramirez G. Promoting weight loss in type 2 diabetes. Diabetes Care. 1996;19(6):613-624.
- Derosa G, Cicero AF, Murdolo G, Ciccarelli L, Fogari R. Comparison of metabolic effects of orlistat and sibutramine treatment in Type 2 diabetic obese patients. Diabetes Nutr Metab 2004;17:222-229.
- Hanefeld M, Sachse G. The effects of orlistat on body weight and glycaemic control in overweight patients with type 2 diabetes: a randomized, placebo-controlled trial. Diabetes, Obesity and Metabolism 2002; 4:415-423.
- Hollander PA, Elbein SC, Hirsch IB, Kelley D, McGill J, Taylor T, Weiss SR, Crockett SE, Kaplan RA, Comstock J, Lucas CP, Lodewick PA, Canovatchel W, Chung J, Hauptman J. Role of orlistat in the treatment of obese patients with type 2 diabetes. Diabetes Care. 1998;21:1288-1294.
- Kelley DE, Bray GA, Pi-Sunyer FX, Klein S, Hill J, Miles J, Hollander P. Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: a 1-year randomized controlled trial. Diabetes Care 2002;25:1033-1041.
- Li Z, Hong K, Saltsman P, DeShields S, Bellman M, Thames G, Liu Y, Wang H-J, Elashoff R, Heber D. Long-term efficacy of soy-based meal replacements vs an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein. Eur J Clin Nutr 2005;59:411-418
- Manning RM, Jung RT, Leese GP, Newton RW. The Comparison of Four Weight Reduction Strategies Aimed at Overweight Patients with Diabetes Mellitus: Four-year Follow-up. Diabetic Medicine 1998;15:497-502.
- Mayer-Davis EJ, D'Antonio AM, Smith SM, Kirkner G, Martin SL, Parra-Medina D, Schultz R. Pounds off with Empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Am J Public Health. 2004;94:1736-1742.
- McNulty SJ, Ur E, Williams G, for the Multicenter Sibutramine Study Group. A randomized trial of sibutramine in the management of obese type 2 diabetic patients treated with metformin. Diabetes Care 2003;125-131.
- Metz JA, Stern JS, Kris-Etherton P, Reusser ME, Morris CD, Hatton DC, Oparil S, Haynes RB, Resnick LM, Pi-Sunyer FX, Clark S, Chester L, McMahon M, Snyder GW, McCarron DA. A randomized trial of improved weight loss with a prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. Arch Intern Med. 2000; 160: 2,150-2,158.
- Miles JM, Leiter L, Hollander P, Wadden T, Anderson JW, Doyle M, Foreyt J, Aronne L and Klein S. Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin. Diabetes Care 2002;25(7):1123-1128.
- Norris SL, Zhang X, Avenell A, Gregg E, Bowman B, Serdula M, Brown TJ, Schmid CH and Lau J. Long-term effectiveness of lifestyle and behavioral weight loss interventions in adults with type 2 diabetes: a meta-analysis. Am J Med 2004 Nov 15;117(10):762-74.
- Redmon JB, Raatz SK, Reck KP, Swanson JE, Kwong CA, Fan Q, Thomas W and Bantle JP. One-year outcome of a combination of weight loss therapies for subjects with type 2 diabetes: a randomized trial. Diabetes Care 2003;26(9):2505-2511.
- Redmon JB, Reck KP, Raatz SK, Swanson JE, Kwong CA, Ji H, Thomas W, Bantle JP. Two-year outcome of a combination of weight loss therapies for Type 2 diabetes. Diabetes Care 2005;28:1311-1315.
- Sanchez-Reyes L, Fanghanel G, Yamamoto J, Martinez-Rivas L, Campos-Franco E, Berber A. Use of sibutramine in overweight adult Hispanic patients with type 2 diabetes mellitus: a 12-month, randomized, double-blind placebo-controlled clinical trial. Clinical Therapeutics 2004; 26(9):1427-1435.
- Vettor R, Serra R, Fabris R, Pagano C and Federspil G. Effect of sibutramine on weight management and metabolic control in type 2 diabetes: a meta-analysis of clinical studies. Diabetes Care 2005;28(4):942-949.
- Wing RR, Koeske R, Epstein LH, Nowalk MP, Gooding W, Becker D. Long-term effects of modest weight-loss in type II diabetic patients. Arch Intern Med. 1987;147:1749-1753.
- Wolf AM, Conaway MR, Crowther JQ, Hazen KY, Nadler JL, Oneida B, Bovbjerg VE. Translating Lifestyle Intervention to Practice in Obese Patients with Type 2 Diabetes: Improving Control with Activity and Nutrition (ICAN) study. Diabetes Care, 2004; 27 (7): 1,570-1,576.
Search Plan and Results: Weight Management 2006