Diet and insulin dose as mediators of insulin-associated weight gain among people in Pakistan with type 2 diabetes

Objective: This paper aims to explore the role of diet in determining insulin-associated weight gain (IAWG) in Pakistani people. Materials and Methods: This observational study was conducted in the Diet and Education Department of Baqai Institute of Diabetology and Endocrinology. The data are obtained from Electronic Health Records from the Health Management System, and it included demographical, anthropometric, clinical, biochemical, and dietary information of the subjects. A total of 917 cases were included in this study, on the basis of inclusion criteria, which were subjects to be of age 18 years and above, diagnosis of type 2 diabetes, and availability of clinical, medical, and dietary data for at least two visits, for subsequent years. Dietary data include energy and macronutrient intake, which is calculated by the system on the basis of food intake data collected and entered by registered dietitians at each visit. Ethical approval for the study was taken from BIDE Institutional Review Board. Results: Differences in the rate of weight gain between insulin-treated and oral antihyperglycemic agents-only-treated groups could not be attributed to differences in dietary changes. Higher intake of insulin in relation to carbohydrate intake was found to be associated with higher weight gain among insulin-treated groups. The rate of weight gain with HbA1c (glycated hemoglobin) increase was lowest among those who had a “decreased” energy intake, with moderate insulin doses, whereas it was highest among those who had high insulin doses with “increased” energy intake. Conclusion: Weight gain was observed following deviation in the macronutrient composition among the insulin users in this study. Dietary intake in relation to body needs for healthy weight and economical doses of insulin appears to have a good potential for inducing normoglycemia without promoting IAWG.