title: Triglyceride/HDL ratio as a screening tool for predicting success at reducing anti-diabetic medications following weight loss.
abstract: OBJECTIVE
  Intentional weight loss, by reducing insulin resistance, results in both better glycemic control and decreased need for anti-diabetic medications. However, not everyone who is successful with weight loss is able to reduce anti-diabetic medication use. In this retrospective cohort study, we assessed the predictive accuracy of baseline triglyceride (TGL)/HDL ratio, a marker of insulin resistance, to screen patients for success in reducing anti-diabetic medication use with weight loss.
  
  
  METHODS
  Case records of 121 overweight and obese attendees at two outpatient weight management centers were analyzed. The weight loss intervention consisted of a calorie-restricted diet (~1000Kcal/day deficit), a behavior modification plan, and a plan for increasing physical activity.
  
  
  RESULTS
  Mean period of follow-up was 12.5 ± 3.5 months. By study exit, mean weight loss and mean HbA1c% reduction were 15.4 ± 5.5 kgs and 0.5 ± 0.2% respectively. 81 (67%) in the study cohort achieved at least 1 dose reduction of any anti-diabetic medication. Tests for predictive accuracy of baseline TGL/HDL ratio ≤ 3 to determine success with dose reductions of anti-diabetic medications showed a sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, likelihood ratio (LR) + and LR-of 81, 83, 90, 70, 78, 4.8 and 0.2, respectively. Reproducibility of TGL/HDL ratio was acceptable.
  
  
  CONCLUSIONS
  TGL/HDL ratio shows promise as an effective screening tool to determine success with dose reductions of anti-diabetic medications. The results of our study may inform the conduct of a systematic review using data from prior weight loss trials.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Ghanshyam
authors.initials: G
authors.lastname: Palamaner Subash Shantha
authors.forename: Anita Ashok
authors.initials: AA
authors.lastname: Kumar
authors.forename: Scott
authors.initials: S
authors.lastname: Kahan
authors.forename: Pavan Kumar
authors.initials: PK
authors.lastname: Irukulla
authors.forename: Lawrence Jay
authors.initials: LJ
authors.lastname: Cheskin
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D015992:Body Mass Index; D031204:Caloric Restriction; D016001:Confidence Intervals; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007333:Insulin Resistance; D016014:Linear Models; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D016017:Odds Ratio; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014280:Triglycerides / Q000097:blood*; D015431:Weight Loss
chemical_list: C034396:HDL-triglyceride; D007004:Hypoglycemic Agents; D008075:Lipoproteins, HDL; D014280:Triglycerides