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Clinical care/education/nutrition/psychosocial research
Determinants of weight change in patients on basal insulin treatment: an analysis of the DIVE registry
  1. Peter Bramlage1,
  2. Tobias Bluhmki2,
  3. Holger Fleischmann3,
  4. Matthias Kaltheuner4,5,
  5. Jan Beyersmann2,
  6. Reinhard W Holl6,7,
  7. Thomas Danne8
  8. for the DIVE study group
  1. 1Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany
  2. 2Institute for Statistics, Ulm University, Ulm, Germany
  3. 3Sanofi Aventis Deutschland GmbH, Berlin, Germany
  4. 4winDiab GmbH, Düsseldorf, Germany
  5. 5Gemeinschaftspraxis Kaltheuner—v. Boxberg, Leverkusen, Germany
  6. 6Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
  7. 7German Center for Diabetes Research (DZD), Munich-Neuherberg, Neuherberg, Germany
  8. 8Kinder- und Jugendkrankenhaus “AUF DER BULT”, Hannover, Germany
  1. Correspondence to Professor Peter Bramlage; peter.bramlage{at}ippmed.de

Abstract

Objective We aimed to describe patterns of weight change in insulin-naive patients with type 2 diabetes mellitus (T2DM) starting basal insulin (BI) treatment.

Research design and methods Diabetes Versorgungs-Evaluation (DIVE) is an observational, multicenter, prospective registry in patients with T2DM. Patients were divided into those initiating BI therapy for the first time (with optional oral antidiabetic drugs (OADs)) and those initiating OADs only (OADo).

Results 521 patients were included in the analysis, 113 in the BI arm and 408 in the OADo arm. Relative to baseline, the BI group gained an average of 0.98±7.1 kg at 1 year, compared with a loss of 1.52±11.8 kg in the OADo group (p<0.001). This difference remained statistically significant when expressed as a proportional change from baseline (+0.014±0.08 vs −0.015±0.12, respectively (p<0.001)). Baseline weight (regression coefficient (RC) 0.89; 95% CI 0.81 to 0.97; p<0.001) and diabetes duration (RC 2.52; 95% CI 0.53 to 4.52; p=0.01) were the only factors identified as significant predictors of weight gain between baseline and 1 year follow-up in BI patients.

Conclusions Though BI therapy leads to modest weight gain over the subsequent year, this may be limited by BI initiation at an early stage of the disease. As such, delaying the start of insulin therapy based on fears of weight gain appears counter-productive, and should be reconsidered.

  • Body Weight
  • Oral Antidiabetics
  • Insulin
  • Adult Diabetes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2016-000301

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    Footnotes

    • Contributors TD and PB designed the registry. TB, JB, and PB outlined the analyses, which were performed by TB. PB and TB drafted the first version of the manuscript, which all other authors revised for important intellectual content. All authors approved the final version of the manuscript that was submitted.

    • Competing interests The registry received funding from Sanofi Aventis Deutschland GmbH. PB, TD and RWH report to have received consultancy honoraria from Sanofi Aventis. HF is an employee of Sanofi Aventis.

    • Patient consent Obtained.

    • Ethics approval Hannover Medical School.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.