Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the diabetes control and complications trial
Dm. Nathan, Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the diabetes control and complications trial, DIABET CARE, 24(10), 2001, pp. 1711-1721
OBJECTIVE - To examine the differential effects of intensive and convention
al 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 18-3
9 years) in the Diabetes Control and Complications Trial were randomly assi
gned to either conventional therapy (1-2 injections of insulin per day) or
intensive therapy (multiple daily injections or continuous subcutaneous inf
usion 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). Bo
dy Composition was assessed cross-sectionally with bioelectrical impedance
analysis during 1992, at which time waist and hip circumferences were measu
red.
RESULTS - Intensively treated patients gained an average of 4.75 kg more th
an their conventionally treated counterparts (P < 0.0001). This represented
excess increases in BMI of 1.5 kg/m(2) among men and 1.8 kg/m(2) among wom
en. 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 greater than or equal to 27.8 kg/m(2) for men, grea
ter than or equal to 27.3 kg/m(2) for women) or experience major weight gai
n (BMI increased greater than or equal to5 kg/m(2)). Waist-to-hip ratios, h
owever, did not differ between treatment groups, Major weight gain was asso
ciated with higher percentages of body fat and greater fat-free mass, but a
mong patients without major weight gain, those receiving intensive therapy
had greater fat-free mass with no difference in adiposity.
CONCLUSIONS - Intensive therapy for type I diabetes produces substantial ex
cess weight gain compared with conventional therapy. However, the additiona
l weight appears to include lean tissue as well as fat.