A clinical score to predict dose reductions of antidiabetes medications with intentional weight loss: A retrospective cohort study.
BACKGROUND
We assessed the predictive accuracy of an empirically-derived score (weight loss, insulin resistance, and glycemic control: "WIG") to predict patients who will be successful in reducing diabetes mellitus (DM) medication use with weight loss.


METHODS
Case records of 121 overweight and obese patients with DM at two outpatient weight management centers were analyzed.


RESULTS
Mean period of follow-up was 12.5 ± 3.5 months. To derive the "WIG" scoring algorithm, one point each was assigned to "W" (loss of 5% of initial body weight within the first 3 months of attempting weight loss), "I" (triglyceride [TGL]/highdensity lipoprotein ratio >3 [marker of insulin resistance] at baseline), and "G" (glycosylated hemoglobin [A1c%] >8.5 at baseline). WIG score showed moderate accuracy in discriminating anti-DM dose reductions at baseline, and after 3 months of weight loss efforts (likelihood ratios [LR] + >1, LR- <1, and area under the curve >0.7), and demonstrated good reproducibility.


CONCLUSIONS
WIG score shows promise as a tool to predict success with dose reductions of antidiabetes medications.
Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Ghanshyam Palamaner Subash
GP
Shantha
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Anita Ashok
AA
Kumar
Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA.
Vimal
V
Ravi
Division of Community Ophthalmology, Allen Foster Research Centre for Community Eye Health, International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India.
Rohit C
RC
Khanna
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy, George Washington University School of Public Health and Health Services, Washington, DC, USA.
Scott
S
Kahan
Johns Hopkins Weight Management Center, Johns Hopkins University, Baltimore, MD, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Obesity Prevention Center at Johns Hopkins University, Baltimore, MD, USA; International Health/Human Nutrition, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: lcheskin@jhsph.edu.
Lawrence J
LJ
Cheskin
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000502:physiology*; D001835:Body Weight / Q000187:drug effects* / Q000502:physiology; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D050177:Overweight / Q000188:drug therapy / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015431:Weight Loss / Q000187:drug effects*
D001786:Blood Glucose; D006442:Glycated Hemoglobin
Clinical score; Diabetes mellitus; Insulin resistance; Obesity