Prediction of excessive weight gain in insulin treated patients with type 2 diabetes

AIMS: Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. However, if prediction of insulin associated weight gain was possible on an individualized level, targeted initiatives could be implemented to reduce weight gain. The objective of this study was to identify predictors of weight gain in insulin treated patients with Type 2 diabetes mellitus.

METHODS: A total of 412 individuals with Type 2 diabetes mellitus were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analogue treatment regimens. Participants with excessive weight gain were defined as the group with weight gain in the 4(th) quartile. We developed a pattern classification method to predict individuals prone to excessive weight gain.

RESULTS: The median weight gain among all patients (n = 412) was 2.4 (95% prediction interval: -5.6 to 12.4) kg and 8.9 (95%: 6.3 to 15.2) kg for the upper 4(th) quartile (n = 103) during the 18 months. No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for the weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a ROC AUC of 0.80.

CONCLUSIONS: We have developed a prediction model that could help to identify a substantial proportion of individuals with Type 2 diabetes prone to large weight gain during insulin therapy.