Association of weight loss and weight loss maintenance following diabetes diagnosis by screening and incidence of cardiovascular disease and all‐cause mortality: an observational analysis of the ADDITION‐Europe trial

BACKGROUND Short-term weight loss may lead to remission of type 2 diabetes but the effect of maintained weight loss on cardiovascular disease (CVD) is unknown. We quantified the associations between changes in weight 5 years following diabetes diagnosis, and incident CVD events and mortality up to 10 years after diagnosis. METHODS Observational analysis of the ADDITION-Europe trial of 2,730 adults with screen-detected type 2 diabetes from the UK, Denmark, and the Netherlands. We defined weight change based on the maintenance at 5-years of weight loss achieved in the year after diabetes diagnosis, and as 5-year overall change in weight. Incident CVD events (n=229) and all-cause mortality (n=225) from years 5-10 follow-up were ascertained from medical records. FINDINGS Gaining >2% weight in the year after diabetes diagnosis was associated with higher hazard of all-cause mortality vs maintaining weight [Hazard Ratio(HR)(95%CI): 3.18(1.30-7.82)]. Losing ≥5% weight 1 year after diagnosis was also associated with mortality, whether or not weight loss was maintained at 5 years [2.47(0.99-6.21) and 2.72(1.17-6.30), respectively]. Losing ≥10% weight over 5 years was associated with mortality among those with BMI<30kg/m2 [4.62(1.87-11.42)]. Associations with CVD incidence were inconclusive. INTERPRETATION Both weight loss and weight gain after screen-detected diabetes diagnosis were associated with higher mortality, but not CVD events, particularly among participants without obesity. The clinical implications of weight loss following diabetes diagnosis are likely to depend on its magnitude and timing, and may differ by BMI status. Personalisation of weight loss advice and support may be warranted. This article is protected by copyright. All rights reserved.