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      The Association of Maximum Body Weight on the Development of Type 2 Diabetes and Microvascular Complications: MAXWEL Study

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          Obesity precedes the development of type 2 diabetes (T2D). However, the relationship between the magnitude and rate of weight gain to T2D development and complications, especially in non-White populations, has received less attention.

          Methods and Findings

          We determined the association of rate and magnitude of weight gain to age at T2D diagnosis (Age T2D), HbA1c at T2D diagnosis (HbA1c T2D), microalbuminuria, and diabetic retinopathy after adjusting for sex, BMI at age 20 years, lifestyles, family history of T2D and/or blood pressure and lipids in 2164 Korean subjects aged ≥30 years and newly diagnosed with diabetes. Body weight at age 20 years (Wt 20y) was obtained by recall or from participants’ medical, school, or military records. Participants recalled their maximum weight (Wt max) prior to T2D diagnosis and age at maximum weight (Age max_wt). The rate of weight gain (Rate max_wt) was calculated from magnitude of weight gain (ΔWt = Wt max–Wt 20y) divided by ΔTime (Age max_wt –20 years). The mean Age max_wt and Age T2D were 41.5±10.9 years and 50.1±10.5 years, respectively. The Wt 20y and Wt max were 59.9±10.5 kg and 72.9±11.4 kg, respectively. The Rate max_wt was 0.56±0.50 kg/year. After adjusting for risk factors, greater ΔWt and higher Rate max_wt were significantly associated with earlier Age T2D, higher HbA1c T2D after additional adjusting for Age T2D, and microalbuminuria after further adjusting for HbA1c T2D and lipid profiles. Greater ΔWt and higher Rate max_wt were also significantly associated with diabetic retinopathy.


          This finding supports public health recommendations to reduce the risk of T2D and its complications by preventing weight gain from early adulthood.

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          Most cited references 33

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          Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

          Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
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            Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.

            Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known. We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years. The mean (+/-SD) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle. Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.
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              Global estimates of the prevalence of diabetes for 2010 and 2030.

              We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                4 December 2013
                : 8
                : 12
                [1 ]Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
                [2 ]Department of Ophthalmology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
                [3 ]Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
                [4 ]Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
                [5 ]Division of General Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
                [6 ]Diabetes Center, Harvard Medical School, Boston, Massachusetts, United States of America
                [7 ]Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
                University of Tolima, Colombia
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: SL MJK SJW SHC KSP. Performed the experiments: SL MJK. Analyzed the data: SL KMK MJK SJW SHC KSP HCJ. Contributed reagents/materials/analysis tools: JBM DJW. Wrote the paper: SL MJK.


                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Pages: 8
                This study was supported by the National Research Foundation grant funded by the Korea government (2006-2005410). SL receives support from Seoul National University Bundang Hospital. DJW is supported by an NIDDK Career Development Award (K23 DK 080228-05). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Research Article



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