The effect of weight loss on fasting blood sugars and hemoglobin A1c in overweight and obese diabetics and non-diabetics

James Stanford, Matthew Kaiser, Elizabeth Ablah, Frank Dong, Bobbie Paull-Forney, James Early

.
Department of Preventive Medicine and Public Health, School of Medicine-Wichita, University of Kansas, Kansas, USA.

DOI: 10.4236/jdm.2012.21021                

Abstract

BACKGROUND: Diet and exercise are recommended first line treatment for overweight, obese, and diabetic patients with the goal of decreasing weight and improving glycemic control. The goal of this study was to determine the effect that a low calorie diet and behavioral modification program, as implemented by a medically supervised weight loss program, would have on the fasting blood sugar and hemoglobin A1c in overweight or obese diabetic and over-weight or obese non-diabetic participants. METHODS: Charts from 2009 to 2010 were reviewed for 310 diabetic and non-diabetic patients enrolled in the Via Christi Weight Management (VCWM) program in Wichita, Kansas. Data were collected before and after patients underwent a program of meal replacements and weekly physical activity lasting 12 weeks. Variables included pre and post treatment fasting blood sugars, hemoglobin A1c, body mass index, percent body weight lost, and diabetes status. RESULTS: Diabetic participants lost an average of 11.7% of their initial body weight (IBW), and non-diabetic patients lost 12.5% of their IBW over the treatment course. Post-treatment average fasting blood glucose (FBG) decreased in both diabetics and non-diabetics by 15.53 mg/dL and 8.46 mg/dL, respectively (p = 0.08). Diabetic patients experienced a significant decrease of 0.83% from pre to post-treatment in hemoglobin A1c. For diabetic and non-diabetic groups, the changes in FBG were correlated with the change in weight. CONCLUSIONS: Diet and exercise, as prescribed by the VCWM program, is effective in reducing hemoglobin A1c in diabetics and reducing fasting blood sugars in both diabetic and non-diabetic patients.

Keywords

Long-Term Weight Maintenance; Hypertension; Diabetes; Hemoglobin A1C; Low-Energy Diets

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ogden, C., Carroll, M., Curtin, L., McDowel, M. and Flegal, K. (2006) Prevalence of overweight and obesity in the United States, 1999-2008. JAMA: Journal of the American Medical Association, 295, 1549-1555. doi:10.1001/jama.295.13.1549
[2]	CDC. (2010) Vital signs: State-specific prevalence of obesity among adults—United States, 2009. Morbidity and Mortality Weekly Report, 59, 1-5.
[3]	Finkelstein, E., Fiebelkorn, I. and Wang, G. (2004) State-level estimates of annual medical expenditures attributable to obesity. Obesity Research, 1, 18-24. doi:10.1038/oby.2004.4
[4]	Dixon, J., Dixon, M. and O’Brien, P. (2003) Depression in association with severe obesity: Changes with weight loss. Archives of Internal Medicine, 163, 2058-2065. doi:10.1001/archinte.163.17.2058
[5]	Resnick, H. V. (2000) Relation of weight gain and weight loss on subsequent diabetes risk in overweight adults. Journal of Epidemiology and Community Health, 54, 596-602. doi:10.1136/jech.54.8.596
[6]	Ford, E., Williamson, D. and Liu, S. (1997) Weigh changes and diabetes incidence: Findings from a national cohort of US adults. American Journal of Epidemiology, 146, 214-222.
[7]	Wilson, P., D’Agostino, R., Sullivan, L., Parise, H. and Kannel, W. (2002) Overweight and obesity as determinants of cardiovascular risk: The Framingham experience. Archives of Internal Medicine, 162, 1867-1872. doi:10.1001/archinte.162.16.1867
[8]	CDC. (2011) National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention
[9]	CDC. (2004) Prevalence of overweight and obesity among adults with diagnosed diabetes—United States, 1988-1994 and 1999-2002. Morbidity and Mortality Weekly Report, 53, 1066-1068.
[10]	Ripsin, C., Kang, H. and Urban, R. (2009) Management of blood glucose in type 2 diabetes mellitus. American Family Physician, 79, 29-36.
[11]	Nathan, D., Buse, J., Davidson, M., Heine, R., Holman, R., Sherwin, R., et al. (2009) Management of hyperglycemia in type 2 diabetes: A consensus algorithm for the initiation and adjustment of therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 32, 193-203. doi:10.2337/dc08-9025
[12]	American Diabetes Association. (2008) Economic costs of diabetes in the U.S. in 2007. Diabetes Care, 31, 596-615.
[13]	Meigs, J., Singer, D., Sulivan, L.M., D. K. and D’Agostino, R. (1997) Metabolic control and prevalent cardiovascular disease in non-insulin dependent diabetes mellitus: The NIDDM Patient Outcome Research Team. American Journal of Medicine, 102, 38-47. doi:10.1016/S0002-9343(96)00383-X
[14]	Wong, T., Klein, R. and Islam, F.E. (2006) Diabetic retinopathy in a multi-ethnic cohort in the United States. American Journal of Ophthalmology, 141, 446. doi:10.1016/j.ajo.2005.08.063
[15]	Lloyd, C., Kuller, L., Ellis, D., Becker, D., Wing, R. and Orchard, T. (1996) Coronary artery disease in IDDM: gender differences in risk factors but not risk. Arteriosclerosis, Thrombosis and Vascular Biology, 16, 720-726. doi:10.1161/01.ATV.16.6.720
[16]	Tesfaye, S., Chaturvedi, N., Eaton, S., Ward, J., Manes, C., Ionescu-Tirgoviste, C., et al. (2005) Vascular risk factors for diabetic neuropathy. New England Journal of Medicine, 352, 341-350. doi:10.1056/NEJMoa032782
[17]	Klein, R., Klein, B.E., Moss, S.E. and Cruickshanks, K.J. (1994) Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Archives of Internal Medicine, 154, 2169-2178. doi:10.1001/archinte.154.19.2169
[18]	Anderson, J., Conley, S. and Nicholas, A. (2007) One hundred pound weight losses with an intensive behavioral program: Changes in risk factors in 118 patients with long-term follow-up. American Journal of Clinical Nutrition, 86, 301-307.
[19]	Furlow, E. and Anderson, J. (2009) A systematic review of targeted outcomes associated with a medically supervised commercial weight loss program. American Dietetic Association, 109, 1417-1421. doi:10.1016/j.jada.2009.05.003
[20]	NIH National Heart Lung and Blood Institute. (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: The evidence report. Obesity Research, 6, 51S-209S.
[21]	The Look AHEAD Research Group. (2010) Long-term effects of a lifestyle intervention on weight and cardiovascular risk Factors in individuals with type 2 diabetes mellitus: Four-year results of the Look AHEAD Trial. Archives of Internal Medicine, 170, 1566-1576. doi:10.1001/archinternmed.2010.334
[22]	The Look AHEAD Research Group. (2007) Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes. Diabetes Care, 30, 1374-1384. doi:10.2337/dc07-0048
[23]	Anderson, J., Grant, L. G. and Stifler, L. (2007) Weight loss and long term follow up in individuals treated with an intense behavioral program. International Journal of Obesity, 31, 488-493. doi:10.1038/sj.ijo.0803541
[24]	Agurs-Collins, T., Kumanyika, S. and Ten Have, T.A.-C. (1997) A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care, 20, 1503-1511. doi:10.2337/diacare.20.10.1503
[25]	Albu, J., Heilronn, L., Kelley, D. and Smith, S. (2010) Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes. Diabetes, 59, 627-633. doi:10.2337/db09-1239
[26]	Kelley, D., Kuller, L.M., Harper, P., Mancino, J. and Kalhan, S. (2004) Effects of moderate weight loss and orlistat on insulin resistance, regional adiposity, and fatty acids in type 2 diabetes. Diabetes Care, 27, 33-40. doi:10.2337/diacare.27.1.33
[27]	Diabetes Prevention Program Research Group. (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346, 393-403. doi:10.1056/NEJMoa012512
[28]	American Diabetes Association. (2010) Standards of medical care in diabetes-2010. Diabetes Care, 33, S11-S61. doi:10.2337/dc10-S011
[29]	Stratton, I., Adler, A., Neil, A., Matthew, D., Manley, S., Cull, C., et al. (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS35): Prospective observational study. British Medical Journal, 321, 405-412. doi:10.1136/bmj.321.7258.405
[30]	Gaede, P., Lund-Andersen, H., Parving, H.-H. and Pedersen, O. (2008) Effect of a multifactorial intervention on mortality in type 2 diabetes. New England Journal of Medicine, 358, 580-591. doi:10.1056/NEJMoa0706245
[31]	DeFronzo, R., Goodman, A. and Group, M. M. (1995) Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. New England Journal of Medicine, 333, 541-549. doi:10.1056/NEJM199508313330902
[32]	Schauer, P., Burguera, B., Ikramuddin, S., Cottam, D., Gourash, W., Hamad, G., et al. (2003). Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Annals of Surgery, 238, 467-484.
[33]	Wing, R., Koeske, R., Epstein, L., Norwalk, M., Gooding, W. and Becker, D. (1987). Long-term effects of modest weight loss in type II diabetic patients. Achives of Internal Medicine, 147, 1749-1753. doi:10.1001/archinte.147.10.1749
[34]	Redmon, B.J., Reck, K., Raatz, S., Swanson, J., Kwong, C., Ji, H., et al. (2005) Two year outcome of a combination of weight loss therapies for type 2 diabetes. Diabetes Care, 28, 1311-1315. doi:10.2337/diacare.28.6.1311