1. Does the weight history of patients with newly diagnosed type 2 diabetes influence the weight changes after diabetes diagnosis? Niels de Fine Olivarius Volkert Siersma Frans Boch Waldorff

2. Objective To study the predictive value of patients’ weight history before diabetes diagnosis for the observed weight changes after diagnosis

3. Study sample Patients included in the present study (n=885) Primary exclusions: Severe somatic disease (n=46) Severe mental illness (n=49) Declined to consent (n=59) Newly diagnosed type 2 diabetic patients (n=1428) Patients included at diabetes diagnosis (n=1274) Died before follow-up (n=319) Withdrew consent ( n=34) Lost to follow-up (n=36) Age at diagnosis = 63.2 years

4. Available body weights ı ı ı ı ı 1 year before diagnosis diabetes diagnosis 6-year follow-up 10 years before diagnosis Age 20 years : Recalled by the patient : Measured by the doctor Body weight (kg) Time in relation to diagnosis (years) Median values of weight for all patients

5. Weight changes before and after diabetes diagnosis ı ı ı ı ı : Recalled by the patient : Measured by the doctor Body weight (kg) Time in relation to diagnosis (years) W(20y) ΔW (-10 → 1) ΔW (-1 → 0) ΔW (0 → 6)

6. Weight changes before diabetes diagnosis Men Women years Age (years) BMI (kg/m 2 )

7. Weight change before and after diabetes diagnosis ΔW (-10 → 1) ΔW (0 → 6) median, kg Weight loss, kg ≥ 10 5-10 0-5 -1.9 -2.6 -2.2 Weight gain, kg 0-5 5-10 > 10 -2.0 -1.8 -3.0 Total-2.5

8. Implications

9. Weight change before and after diabetes diagnosis ΔW (-10 → -1) ΔW (0 → 6) Weight loss, kgWeight gain, kg >105-100-5 5-10>10 Weight loss, kg ≥ 10 5-10 0-5 15 7 25 10 13 49 16 22 69 16 23 54 5 1 16 827827 Weight gain, kg 0-5 5-10 > 10 17 19 31 33 32 31 48 43 42 32 12 10 8 315315 Number of patients Variability!

10. Possible predictor of weight change after diabetes diagnosis, ΔW (0 → 6) Sex Age BMI ΔW (-10 → -1) ΔW (-1 → 0) W(20y) Living alone Education Familial disposition to DM Diagnostic plasma glucose Fasting triglycerides Total cholesterol Urinary albumin Resting heart rate Systolic blood pressure Physical activity Smoking Cardiovascular disease Diabetic retinopathy Peripheral neuropathy Cancer (former or present) Allocation to type of care [Antidiabetic treatment at 6-year follow-up]

11. Predictors of ΔW (0 → 6) Multivariate analyses, p<0.01 ** p<0.01 *** p<0.001 Linear regression models

12. Age and ΔW (0 → 6) Time relative to diagnosis (years) Body weight (kg) Age at diagnosis: 40-50 (n=143) 50-60 (n=220) 60-70 (n=270) 80+ (n=44) 70-80 (n=208)

13. BMI and ΔW (0 → 6) Body weight (kg) Time relative to diagnosis (years) BMI at diagnosis: ≥ 35 (n=131) 30-35 (n=265) 25-30 (n=336) < 25 (n=148)

14. ΔW (-10 → -1) and ΔW (0 → 6) Time relative to diagnosis (years) Body weight (kg) Weight gain >2 kg (n=412) Stable weight (n=239) Weight loss >2 kg (n=177)

15. ΔW (-1 → -0) and ΔW (0 → 6) Time relative to diagnosis (years) Body weight (kg) Weight gain >2 kg (n=169) Stable weight (n=286) Weight loss >2 kg (n=373)

16. Conclusions (1) Weight changes before and after diabetes diagnosis are subject to high interindividual variability

17. Conclusions (2) Weight change after diabetes diagnosis is not predicted by weight change from 10 to 1 year before diagnosis but by age, BMI and weight change immediately before diagnosis

19. Predictors of ΔW (0 → 6) Univariate analyses, p<0.01 ** p<0.01 *** p<0.001 Linear regression models

20. Diagnostic plasma glucose and ΔW (0 → 6) Time relative to diagnosis (years) Body weight (kg) Diagnostic plasma glucose (mmol/l): Red: <10 (n=148) Blue: 10-17 (n=511) Green: ≥ 17 (n=226)

21. Antidiabetic treatment at 6- year follow-up and ΔW (0 → 6) Time relative to diagnosis (years) Body weight (kg) Antidiabetic treatment at 6-year follow-up: Oral agents (n=508) Diet alone (n=264) Insulin (n=112)