Patients with Pre-diabetes Who Lose Greater Amounts of Weight Have Greater Reductions in Medical Risk Factors and Medication Use

Modest weight loss, through lifestyle change, has been shown to be the most important task for people with pre-diabetes to improve their health. However, health professionals are often unsure whether to encourage patients to lose greater amounts of weight and obtain perhaps even greater health benefits. The objectives of this study were to document the lifestyle and medical risk factor changes in patients with pre-diabetes, who lost weight in an ongoing treatment program, and to assess the health effects by the amount of weight lost. Patients with pre-treatment fasting plasma glucose ≥ 100 mg/dl and not taking diabetes medications (n=198) who participated in The HMR Program for Weight Management™ were assessed. HMR^® (Health Management Resources^®) is a structured behavioral program that focuses on specific lifestyle changes (physical activity, vegetable/fruit intake and use of meal replacements for portion control). Patients with health risk appraisals (HRAs) at program entry and follow-up HRAs completed between 1/1/08 to 2/28/09 were assessed. 60.6% (n=120) were women. The average initial weight was 256 lbs. and 40 kg/m² BMI. Overall, patients lost an average of 44 lbs. or 17.2% of initial body weight over an average of 3 years (157.6 weeks). Patients reduced the average number of elevated risk factors from 7 to 3 by making substantial changes in diet (decreased from 38% to 28% fat) and physical activity calories (644 to 1857 kcals/wk). All measured medical risk factors decreased: total cholesterol/HDL -14.1%; triglycerides -22.8%; fasting blood glucose -10.2%; systolic and diastolic blood pressure by -7 and -5 mm/Hg respectively. When analyzed by weight change category (losing ≥ 100 lbs; 99-50 lbs; 49-1 lb; or weight gain), numerous differences were found. Significant differences (p<.05) and dose-response relationships between weight groups were found for fasting blood glucose, TC/HDL, triglycerides, and both systolic and diastolic blood pressure. A dose-response relationship was also found between amount of weight loss and the percent of patients using diabetes medications at follow-up: 0%, 1.8%, 6.3% and 10.5%. In summary, although patients with pre-diabetes in all the weight loss categories had substantial health benefits, those who lost the most weight tended to have the greatest changes in risk factors.