Weight gain was associated with worsening glycemia and cardiovascular and kidney outcomes in type 2 diabetes patients independent of diabetes medication in the GRADE Randomized Controlled Trial

Objective: Weight gain with glucose-lowering medications may interfere with effective type 2 diabetes (T2D) management. We evaluated weight change and the effect of weight gain on outcomes over 5 years on four diabetes medications.

Research Design and Methods: The GRADE randomized trial compared the addition of insulin glargine, glimepiride, liraglutide, or sitagliptin to metformin in participants with T2D. We report weight change and hazard ratio (HR) per kg of weight change for HbA1c>7.5%; cardiovascular (CVD), kidney, and neuropathy outcomes; and diabetes treatment satisfaction.

Results: Participants (n=4,980) were 57+10 years, 44% non-White, with HbA1c 7.5%+0.5% and BMI 34.3+6.8kg/m2. Mean (95% CI) weight change (kg) during the first year was -3.5 (-3.8, -3.2) with liraglutide, -1.07 (-1.4, -0.78) with sitagliptin, 0.45 (0.16, 0.74) with glargine, and 0.89 (0.60, 1.2) with glimepiride (P<0.0001). Thereafter, weight decreased in all groups. Weight gain within the first six months was associated with increased risk of HbA1c>7.5%, with modest differences by treatment, and with subsequent CVD (HR 1.03 [1.005, 1.06]). Weight gain at 1 year was associated with increased risk of HbA1c>7.5% (HR 1.05 [1.04, 1.07]) and kidney disease (HR 1.03 [1.01, 1.06]). Baseline weight, but not weight gain, was associated with new-onset neuropathy. Weight gain was associated with lower diabetes treatment satisfaction.

Conclusions: Liraglutide and sitagliptin were associated with initial weight loss and glargine and glimepiride with slight weight gain followed by weight loss in metformin-treated T2D. Weight gain was associated with worsening glycemia and increased risk of cardiovascular and kidney outcomes largely independent of treatment.