Thursday, September 24, 2020

Increased Waist Circumference with Weight Loss Can Raise CVD Risks

The Diabetes Prevention Program (DPP) trials is a landmark study that proved that intensive lifestyle intervention (ILI) can delay or prevent type 2 diabetes. Because of the success of the DPP trials, another study called the Look AHEAD  study was carried out. The purpose of the Look AHEAD study was to determine if ILI could reduce "cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes.” A secondary analysis of the study was also done to determine the relationship between cardiovascular disease (CVD), waist circumference (WC) and weight loss.

The Look AHEAD failed to conclusively show that ILI could reduce cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes, however, the study was a useful study. In the secondary analysis, the investigators concluded that even with weight loss, an increase in waist circumstance can cause an increase in CVD risk.

The analysis consisted of 5,490 participants, where four groups were formed. One group consisted of participants that had lost weight and reduced WC, another group that had gained weight and increased WC, a group that had gained weight and reduced WC and a group that had lost weight and increased WC. All changes happened within one year of baseline.

The researchers performing the secondary analysis concluded that "increased WC during the first year of ILI, independent of weight change, was associated with higher risk for subsequent cardiovascular outcomes."

Still, it should be noted that, in general, weight loss via ILI is associated with a lowering of the risk of negative cardiovascular outcomes. Further, in one Look AHEAD follow-on study that used machine-learning methods to analyze the Look AHEAD data, the investigators concluded that 85% of the Look AHEAD subjects did, in fact, experience a significant reduction in cardiovascular events as a result of weight loss.

It is possible to have an increase in CVD risk with weight loss, if there is a rise in WC. And while providers should be aware of the possibility of increased CVD risk with a rise in WC, employing ILI for weight loss is still a prudent approach to possibly lower CVD risks.

 -------------------------------------------------------

Tags: , , , , bariatric medicine, obesity medicine, medical practice start up, bariatric industry analysis, weight loss industry analysis, weight management industry analysis

Tuesday, September 22, 2020

Less Stringent ADA Prediabetes Criteria vs More Stringent Criteria

The CDC’s diabetes prevention program (DPP) treats prediabetes to enable an individual to avoid or delay type 2 diabetes. The general definition of prediabetes is something like the following: prediabetes is where an individual has abnormally high blood glucose, but the blood glucose is not high enough to be called diabetes. The criteria used by the DPP to determine the abnormally high blood glucose is based on the criteria used by the American Diabetes Association (ADA) and the CDC. However, the criteria used by the ADA and the CDC differ from the criteria used by the World Health Organization (WHO), and the National Institute for Health and Care Excellence (NICE).

The prediabetes criteria used by WHO and NICE are more stringent than the prediabetes criteria used by the ADA and the CDC. So a study was done “to evaluate the associations between different definitions of prediabetes and the risk of cardiovascular disease and all cause mortality.”

The ADA uses the following criteria for prediabetes: a fasting plasma glucose (FPG) greater than or equal to 100 mg/dL and less than or equal to 125 mg/dL; an impaired glucose tolerance (IGT) where the glucose is greater than or equal to 140 mg/dL and less than or equal to 200 mg/dL; and hemoglobin A1c greater than or equal to 5.7% and less than or equal to 6.4%.

The WHO uses the following criteria for prediabetes: an FPG greater than or equal to 110 mg/dL and less than or equal to 125 mg/dL; an IGT where the glucose is greater than or equal to 140 mg/dL and less than or equal to 200 mg/dL. NICE uses a hemoglobin A1c of 6.0-6.4% as it's criteria.

The above referenced study took the form of a meta analysis where 53 studies were included. The studies consisted of 1,611,339 subjects. The subjects were looked at for a period of about 9 ½ years. The investigators concluded that individuals who satisfied the less stringent ADA prediabetes criteria experienced an increased risk of “cardiovascular events, coronary heart disease, stroke, and all cause mortality.”

Further, because prediabetes can increase the risk of metabolic problems, investigators suggested that “high risk populations with prediabetes, especially combined with other cardiovascular risk factors, should be selected for controlled trials of pharmacological treatment.”

-------------------------------------------------------

 

Subscribe to Overfat Strategy Blog by Email