Magnitude of A1C improvement in relation to baseline A1C and amount of weight loss in response to intensive lifestyle intervention in real-world diabetes practice: 13 years of observation

Ahmed H Eldib; Shilton Dhaver; Marwa Al-Badri; Tareq Salah; Karim Kibaa; Omnia Elenani; Shaheen Tomah; Hannah Gardner; Osama Hamdy

doi:10.1111/1753-0407.13395

Magnitude of A1C improvement in relation to baseline A1C and amount of weight loss in response to intensive lifestyle intervention in real-world diabetes practice: 13 years of observation

J Diabetes. 2023 Jun;15(6):532-538. doi: 10.1111/1753-0407.13395. Epub 2023 May 16.

Authors

Ahmed H Eldib^{1

2}, Shilton Dhaver¹, Marwa Al-Badri^{1

2}, Tareq Salah^{1

2}, Karim Kibaa^{1

2}, Omnia Elenani^{1

2}, Shaheen Tomah^{1

2}, Hannah Gardner¹, Osama Hamdy^{1

2}

Affiliations

¹ Joslin Diabetes Center, Boston, Massachusetts, USA.
² Harvard Medical School, Boston, Massachusetts, USA.

Abstract
in English, Chinese

Background: Effect of intensive lifestyle intervention (ILI) on A1C in participants with diabetes is underestimated. A1C improvement is presumed to be dependent on the amount of weight loss. Here, we evaluate the magnitude of A1C change in relation to baseline A1C and the amount of weight loss in participants with diabetes who underwent ILI over 13 years in real-world clinical practice.

Methods: A total of 590 participants with diabetes were enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week multidisciplinary ILI program designed for real-world clinical practice between September 2005 and May 2018. We stratified participants based on baseline A1C into three groups: group A: A1C ≥ 9%, group B: A1C 8 to <9%, and group C: A1C ≥6.5% to <8%.

Results: After 12-weeks of intervention, body weight decreased in all groups, and pairwise comparisons of A1C changes showed that: group A had 1.3% greater A1C reduction than group B (p = 0.0001) and 2% greater than group C (p = 0.0001), while group B had 0.7% greater A1C reduction than group C (p = 0.0001).

Conclusion: We conclude that ILI may decrease A1C by up to 2.5% in participants with diabetes. At similar magnitude of weight loss, A1C reduction was more prominent in participants with higher baseline A1C. This may be valuable for clinicians to set a realistic expectation of A1C change in response to ILI.

【摘要】背景强化生活方式干预(ILI)对于糖尿病患者的HbA_1C 效果被低估。HbA_1C 的改善被认为依赖于体重的减少程度。在真实世界的临床实践中，本研究评估了在经历13年以上强化生活方式干预的糖尿病患者中，与基线HbA_1C 相关的HbA_1C 变化幅度与体重减轻程度。方法从2005年9月至2018年5月，在真实世界的临床实践中，共有590例糖尿病患者参加了体重达标和强化治疗(Why WAIT)项目，这是1个为期12周的多学科ILI项目。本研究根据基线HbA_1C 将参与者分为3组:A组:HbA_1C >9%，B组:HbA_1C 8%~9%，C组:HbA_1C 6.5%~8%。结果经过12周的干预后，所有组患者的体重均有所下降，HbA_1C 变化的两两比较显示:A组的HbA_1C 降低幅度比B组高1.3%(P=0.0001)，比C组高2%(P=0.0001)，而B组的HbA_1C 降低幅度比C组高0.7%(P=0.0001)。结论本研究提示，ILI可能使糖尿病患者的HbA_1C 降低高达2.5%。在相似的体重减轻幅度下，基线HbA_1C 较高的参与者HbA_1C 降低更为明显。这对临床医生来说，设置与ILI相应的HbA_1C 变化的现实预期可能是有价值的。.

Keywords: A1C reduction; HbA1C降低; diabetes; glycemic control; intensive lifestyle intervention; weight loss; 减重; 强化生活方式干预; 糖尿病; 血糖控制.

MeSH terms

Diabetes Mellitus, Type 2* / drug therapy
Glycated Hemoglobin
Humans
Life Style
Weight Loss

Substances

Glycated Hemoglobin

Abstract in English, Chinese

MeSH terms

Substances

Abstract
in English, Chinese