Dorte Vistisen, PhD, from the Steno Diabetes Center in Gentofte, Denmark, and colleagues analyzed change in body mass index (BMI) and other cardiometabolic risk factors in 6,705 British civil servants who were initially without diabetes. Participants underwent clinical examinations every five years for a median of 14.1 years.
During follow-up, the researchers found that 645 individuals developed type 2 diabetes and 6,060 remained free of diabetes. Most of those who developed diabetes (94%; 604 individuals) were classified as “stably overweight,” with a relatively constant BMI level within the overweight category. From five years prior to diagnosis, they experienced slightly worsening beta cell function and insulin sensitivity. The remaining participants were classified as either “progressive weight gainers” or “persistently obese.” Progressive weight gainers had consistent weight gain before diagnosis (15 individuals) and experienced an exponential increase in insulin resistance in the years preceding diagnosis. The persistently obese were severely obese for 18 years before diagnosis (26 individuals) and experienced an initial beta cell compensation followed by loss of beta cell function, with relatively stable insulin sensitivity.
“These results suggest that strategies focusing on small weight reductions for the entire population may be more beneficial than predominantly focusing on weight loss for high-risk individuals,” Vistisen and colleagues conclude.
The Steno Diabetes Center is owned by Novo Nordisk. Several authors own shares in the company.