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

Background Weight gain is an ongoing challenge when initiating insulin therapy in patients with type 2 diabetes mellitus (T2DM). However, if prediction of insulin‐associated weight gain was possible on an individual level, targeted initiatives could be implemented to reduce weight gain. The aim of the present study was to identify predictors of weight gain in insulin‐treated patients with T2DM. Methods In all, 412 individuals with T2DM were, in addition to metformin or placebo, randomized into 18‐month treatment groups with three different insulin analog treatment regimens (biphasic, aspart, detemir). Participants with excessive weight gain were defined as the group with weight gain in the 4th quartile (>6.2 kg).We developed a pattern classification method to predict individuals prone to excessive weight gain. Results Over the 18‐month treatment period, median weight gain among all 412 patients was 2.4 kg (95% prediction interval [PI] –5.6, 12.4 kg), whereas median weight gain for those in the upper 4th quartile (n = 103) was 8.9 kg (95% PI 6.3, 15.2 kg). 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 weight gain at the 18‐month follow‐up. Combining these two predictors into a prediction model with other clinical available information produced a receiver operating characteristic area under the curve of 0.80. Conclusions We have developed a prediction model that could help identify a substantial proportion of individuals with T2DM prone to large weight gain during insulin therapy. 背景: 对于启动胰岛素治疗的2型糖尿病(T2DM)患者来说体重增加是一个持续存在的挑战。然而,如果我们能够在个体水平上预测胰岛素相关的体重增加,就可以采取针对性的举措以减少体重增加。当前这项研究的目的是在使用胰岛素治疗的T2DM患者中确定体重增加的预测因子。 方法: 总共纳入了412名T2DM患者,除了使用二甲双胍或安慰剂以外,被随机分配到3个不同的胰岛素类似物(双时相胰岛素、门冬胰岛素、地特胰岛素)治疗组中进行为期18个月的治疗。患者体重过度增加的定义为在治疗组中体重增加处于第4个四分位数( > 6.2 kg)。我们开发了一种模式分类法用来预测患者是否倾向于体重过度增加。 结果: 在超过18个月的治疗期间,所有412名患者的体重增加中位数为2.4 kg(95%预测区间[PI]为‐5.6,12.4 kg),然而处于第4个四分位数的患者(n = 103)的体重增加中位数为8.9 kg(95% PI为6.3,15.2 kg)。没有一个临床基线数据是体重过度增加的强力预测因子。然而,试验前3个月期间的体重增加以及随后的胰岛素剂量是在18个月随访期间体重增加的强力预测因子。将这两个预测因子整合到一个包含其他临床可用信息的预测模型后产生的受试者工作特征曲线下面积为0.80。 结论: 我们开发的这个模型能够帮助我们预测相对一部分T2DM患者在胰岛素治疗期间倾向于体重过度增加。 Receiver operating characteristic curves of models for the prediction of excessive weight gain using baseline information (Model A) and both baseline and 3‐month follow‐up data (Model B), and coefficient estimates of Model B.