Weight Change, Lifestyle and Mortality in Patients With Type 2 Diabetes

<title>Abstract</title> <bold>Background: </bold>Whether weight change around type 2 diabetes (T2D) diagnosis is associated with long-term survival is unclear. We aimed to examine the association between weight change and mortality among participants with incident T2D and evaluate impacts of lifestyle on this association. <bold>Methods: </bold>This prospective analysis included 11,262 incident T2D patients from the Nurses’ Health Study and Health Professionals Follow-up Study. We assessed weight change bracketing T2D diagnosis in relation to mortality. We also examined potential effect modification by a healthy lifestyle consisting of high-quality diet, regular physical activity, non-smoking status and moderate alcohol consumption.<bold>Results:</bold> On average, T2D patients lost 2.3 kg during a two-year time-window spanning the T2D diagnosis, and body weight increased afterwards. Compared with patients with a stable weight, T2D patients who lost ≥10% body weight had a 26% (95% CI: 4%, 52%) increased mortality due to cardiovascular disease (CVD). Lifestyle significantly modified these associations: the hazard ratios (95% CIs) of CVD mortality comparing ≥10% weight loss with stable weight were 1.41 (0.87, 2.30) among participants with a deteriorated lifestyle, 1.46 (1.15, 1.86) for a stable lifestyle, and 0.82 (0.53, 1.27) for an improved lifestyle (<italic>P</italic>_interaction &lt;0.001). Major weight loss was also associated with an increased all-cause mortality, and similar effect modifications by lifestyle were observed.<bold>Conclusions</bold>: Significant weight loss upon T2D incidence was associated with an increased CVD mortality, although improved lifestyle quality abolished these associations. These results highlight the role of adopting a healthy lifestyle for newly diagnosed T2D patients in improving long-term survival.