Weight change in intensive insulin therapy for type 2 diabetes mellitus as a function of glycosylated hemoglobin (A1C) level achieved: The deep south diabetes program

Abstract

Background: The Deep South Diabetes Program (DSDP) conducted a retrospective study to evaluate weight changes associated with intensive basal-bolus insulin therapy. Results of the effectiveness of the treatment algorithm that was used in this study were published in the April 2008 issue of Insulin.

Objectives: The current study was designed to further evaluate the results of the DSDP study. The primary objective was to determine the quantitative relationship between weight gain and the patient's final glycosylated hemoglobin (A1C) level achieved. A secondary objective was to gain a qualitative understanding of the treatment parameters underlying the quantitative results.

Methods: Further evaluation of the DSDP treatment algorithm in terms of weight management and A1C levels for achieving normoglycemia or near-normoglycemia was performed retrospectively using data collected in the original DSDP study. This evaluation included all patients who elected intensive basal-bolus insulin therapy and who sustained the treatment for up to 4 years. Glargine was the primary basal insulin, and aspart was the primary bolus insulin. The quantitative relationships among net weight change, net A1C change, and final A1C level achieved were evaluated. A qualitative evaluation of glycemic variability and behavioral variables was made from video recordings of patient visits during the original DSDP study and further observation of study participants after completion of the study.

Results: Quantitative evaluation of change in weight as a function of A1C level achieved at the end of the study showed that for the group of patients who achieved normoglycemia, the mean change in weight was a reduction proportional to the corresponding mean reduction in A1C. For the groups of patients who did not achieve normoglycemia or near-normoglycemia, the mean change in weight was an increase proportional to the corresponding mean reduction in A1C.

Conclusions: When normoglycemia was achieved and sustained using the DSDP's intensive insulin therapy, the weight gain typically seen with conventional insulin therapy did not occur. Weight gain or loss during intensive insulin therapy using the DSDP treatment algorithm was a function of A1C level achieved.