title: Determinants of weight gain in the action to control cardiovascular risk in diabetes trial.
abstract: OBJECTIVE
  Identify determinants of weight gain in people with type 2 diabetes mellitus (T2DM) allocated to intensive versus standard glycemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
  
  
  METHODS
  We studied determinants of weight gain over 2 years in 8,929 participants (4,425 intensive arm and 4,504 standard arm) with T2DM in the ACCORD trial. We used general linear models to examine the association between each baseline characteristic and weight change at the 2-year visit. We fit a linear regression of change in weight and A1C and used general linear models to examine the association between each medication at baseline and weight change at the 2-year visit, stratified by glycemia allocation.
  
  
  RESULTS
  There was significantly more weight gain in the intensive glycemia arm of the trial compared with the standard arm (3.0 ± 7.0 vs. 0.3 ± 6.3 kg). On multivariate analysis, younger age, male sex, Asian race, no smoking history, high A1C, baseline BMI of 25-35, high waist circumference, baseline insulin use, and baseline metformin use were independently associated with weight gain over 2 years. Reduction of A1C from baseline was consistently associated with weight gain only when baseline A1C was elevated. Medication usage accounted for <15% of the variability of weight change, with initiation of thiazolidinedione (TZD) use the most prominent factor. Intensive participants who never took insulin or a TZD had an average weight loss of 2.9 kg during the first 2 years of the trial. In contrast, intensive participants who had never previously used insulin or TZD but began this combination after enrolling in the ACCORD trial had a weight gain of 4.6-5.3 kg at 2 years.
  
  
  CONCLUSIONS
  Weight gain in ACCORD was greater with intensive than with standard treatment and generally associated with reduction of A1C from elevated baseline values. Initiation of TZD and/or insulin therapy was the most important medication-related factor associated with weight gain.
authors: Tulane University Health Sciences Center, New Orleans, Louisiana, USA. vfonseca@tulane.edu
authors: Vivian
authors: V
authors: Fonseca
authors: Roberta
authors: R
authors: McDuffie
authors: Jorge
authors: J
authors: Calles
authors: Robert M
authors: RM
authors: Cohen
authors: Patricia
authors: P
authors: Feeney
authors: Mark
authors: M
authors: Feinglos
authors: Hertzel C
authors: HC
authors: Gerstein
authors: Faramarz
authors: F
authors: Ismail-Beigi
authors: Timothy M
authors: TM
authors: Morgan
authors: Rodica
authors: R
authors: Pop-Busui
authors: Matthew C
authors: MC
authors: Riddle
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D012306:Risk; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use*; D013997:Time Factors; D015430:Weight Gain
chemical_list: D006442:Glycated Hemoglobin; D008687:Metformin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones