title: Evaluation of the relationship between weight change and glycemic control after initiation of antidiabetic therapy in patients with type 2 diabetes using electronic medical record data.
abstract: OBJECTIVE
  This study evaluates the relationship between HbA1c and weight change outcomes by anti-diabetic weight-effect properties in patients newly treated for type 2 diabetes; a relationship not previously characterized.
  
  
  METHODS
  Electronic medical records of patients with type 2 diabetes newly prescribed anti-diabetic monotherapy were assessed to identify HbA1c goal attainment [(<53 mmol/mol)] and weight change at 1-year. Anti-diabetics were categorized by weight-effect properties: weight-gain (sulfonylureas, thiazolidinediones) and weight-loss/neutral (metformin, DPP-4 inhibitors, GLP-1 agonists). Logistic regression analyses identified likelihood of attaining HbA1c goal or ≥3% weight loss by anti-diabetic category controlling for baseline characteristics. MANOVA was used to identify correlation between changes in weight and HbA1c.
  
  
  RESULTS
  The study included 28,290 patients. Mean age ± sd was 61 years ±11.8. Baseline HbA1c was 7.4% ± 1.6 (57 mmol/mol ± 17); 67.3% were prescribed a weight-loss/neutral anti-diabetic. At 1-year, more patients in the weight-loss/neutral anti-diabetic category lost weight (≥3%) than in the weight-gain anti-diabetic category (40.4% vs. 24.2%, p<0.001) or had an HbA1c<7.0% (<53 mmol/mol) (71.1% vs. 63.8%, p<0.001). Those prescribed a weight-gain anti-diabetic were 53% less likely to lose weight and 29% less likely to be at HbA1c goal than those prescribed a weight-loss/neutral anti-diabetic (p<0.001). Weight loss and HbA1c outcomes were significantly correlated (p<0.001).
  
  
  CONCLUSIONS
  Weight loss of ≥3% was associated with better glycemic control in patients newly treated for type 2 diabetes. Anti-diabetics associated with weight-loss/neutrality were associated with greater weight loss and HbA1c goal attainment and may facilitate efforts to co-manage weight and glycemia in the ambulatory-care setting.
authors: University of Utah, Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA. Electronic address: carrie.mcadam-marx@pharm.utah.edu.
authors: Carrie
authors: C
authors: McAdam-Marx
authors: Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Wallingford, CT, USA.
authors: Jayanti
authors: J
authors: Mukherjee
authors: University of Utah, Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA.
authors: Brandon K
authors: BK
authors: Bellows
authors: University of Utah, Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA.
authors: Sudhir
authors: S
authors: Unni
authors: University of Utah, Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA.
authors: Xiangyang
authors: X
authors: Ye
authors: Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Wallingford, CT, USA.
authors: Uchenna
authors: U
authors: Iloeje
authors: University of Utah, Pharmacotherapy Outcomes Research Center, Salt Lake City, UT, USA.
authors: Diana I
authors: DI
authors: Brixner
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015430:Weight Gain / Q000187:drug effects; D015431:Weight Loss / Q000187:drug effects; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Electronic medical records; HbA1c; Outcomes; Type 2 diabetes; Weight