title: Weight change after initiation of oral hypoglycemic monotherapy for diabetes predicts 5-year mortality: An observational study.
abstract: OBJECTIVE
  To investigate whether weight change in the first year after initiating an oral hypoglycemic agent (OHA) for type 2 diabetes treatment is associated with mortality in a national cohort.
  
  
  METHODS
  We prospectively followed Veterans Health Administration patients with type 2 diabetes initiating treatment with an OHA and not receiving any other diabetes pharmacotherapy for at least one year. Information on OHAs, weight, co-morbidities, other medications, demographics, and laboratory measurements was obtained from electronic medical records. Logistic regression was used to estimate 5-year mortality odds by weight change during the first year after OHA treatment initiation.
  
  
  RESULTS
  Patients (mean age 65years, 97% male, mean BMI 32.3kg/m2) initiating OHA monotherapy between 2003 and 2008 totaled 145,198 (metformin n=89,111, glipizide n=27,100, glyburide n=25,226, rosiglitazone n=3,761). Most patients (65%) maintained a stable weight (change ⩽5% from baseline) during the first year after OHA initiation. Those losing >5% of baseline weight had a significantly higher odds of death over the subsequent 5-years ranging from 1.64 to 2.13 depending on OHA type. In the metformin group, weight gain >5% of baseline was also associated with higher odds of 5-year mortality. The same results were obtained after conducting three sensitivity analyses that excluded patients for the following reasons: weight loss in the one year prior to OHA initiation, weight change >100lbs, or weight change >50lbs.
  
  
  CONCLUSIONS
  Weight loss was associated with higher odds of 5-year mortality among patients initiating an OHA, as was weight gain for metformin only.
authors.affiliation: General Medicine and Hospital and Specialty Medicine Services, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, University of Washington, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Beverly M
authors.initials: BM
authors.lastname: Kocarnik
authors.affiliation: Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Moore
authors.affiliation: Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
authors.affiliation: General Medicine and Hospital and Specialty Medicine Services, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. Electronic address: eboyko@uw.edu.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D007004:Hypoglycemic Agents
keywords: Epidemiology; Mortality; Oral hypoglycemic medication; Prospective research; Weight change