Influence of Intensive Diabetes Treatment on Body Weight and Composition of Adults With Type 1 Diabetes in the Diabetes Control and Complications Trial

Disclosures

Diabetes Care. 2001;24(10):1711-172. 

In This Article

Abstract and Introduction

Abstract

Objective: To examine the differential effects of intensive and conventional diabetes therapy on weight gain and body composition in adults with type 1 diabetes.
Research design and methods: Between 1982 and 1989, 1,246 adults (aged 18-39 years) in the Diabetes Control and Complications Trial were randomly assigned to either conventional therapy (1-2 injections of insulin per day) or intensive therapy (multiple daily injections or continuous subcutaneous infusion with frequent blood-glucose testing). Height and weight were measured at baseline and at annual visits for an average of 6 years (range 3-9). Body composition was assessed cross-sectionally with bioelectrical impedance analysis during 1992, at which time waist and hip circumferences were measured.
Results: Intensively treated patients gained an average of 4.75 kg more than their conventionally treated counterparts (P < 0.0001). This represented excess increases in BMI of 1.5 kg/m2 among men and 1.8 kg/m2 among women. Growth-curve analysis showed that weight gain was most rapid during the first year of therapy. Intensive therapy patients were also more likely to become overweight (BMI ≥27.8 kg/m2 for men, ≥27.3 kg/m2 for women) or experience major weight gain (BMI increased ≥5 kg/m2). Waist-to-hip ratios, however, did not differ between treatment groups. Major weight gain was associated with higher percentages of body fat and greater fat-free mass, but among patients without major weight gain, those receiving intensive therapy had greater fat-free mass with no difference in adiposity.
Conclusions: Intensive therapy for type 1 diabetes produces substantial excess weight gain compared with conventional therapy. However, the additional weight appears to include lean tissue as well as fat.

Introduction

Greater weight gain was associated with intensive compared with conventional diabetes treatment during the first year of the Diabetes Control and Complications Trial (DCCT)[1]. That observation was made during the DCCT's feasibility phase in the early 1980s, when 278 subjects were followed for 1 year. Additional patients (n = 1,163) were subsequently entered into the DCCT; a total of 1,441 patients were studied for an average of 6.5 years (range 3.5-9).

As previously reported, intensive therapy significantly reduced the risk of development and progression of retinopathy, nephropathy, and neuropathy compared with conventional therapy[2]. The major adverse effect of intensive therapy was a threefold increase in severe hypoglycemia[2]. After the increased rate of hypoglycemia, weight gain and heightened risk of obesity represent the most conspicuous side effects of intensive treatment observed in the DCCT. In the general population, obesity is associated with increased risks of hypertension, dyslipidemia, cardiovascular disease, gallstones and cholecystitis, respiratory dysfunction, certain forms of cancer, and type 2 diabetes. In individuals with type 1 diabetes, however, it is not clear what role excessive weight gain has in the development and/or progression of these and other disease outcomes.

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