Abstract Aims This study aimed to evaluate the impact of intentional weight loss on the risk of microvascular and macrovascular complications in people with obesity and type 2 diabetes (T2D), while accounting for changes in glycaemic control. Materials and Methods Data from adults living with obesity (body mass index BMI ≥30 kg/m 2 ) and T2D were extracted from Clinical Practice Research Datalink (CPRD) Aurum database from 2006 to 2022. Incidence of microvascular (retinopathy, neuropathy, and chronic kidney disease CKD) and macrovascular (myocardial infarction MI, peripheral artery disease PAD, and stroke) complications following a 4‐year intentional weight loss period were quantified, and risk of outcomes estimated using Cox proportional hazard regression. Results Data from 100 507 people (mean age 53.3 years; 58% male) was included. Mean SD relative reduction in BMI was −2.2% 9.1% and mean SD absolute change in HbA 1c was 0.0% 1.9%. Risk of composite microvascular and macrovascular complications was significantly reduced per 1% BMI reduction (hazard ratio HR 0.990 95% CI 0.988, 0.992 and 0.996 95% CI 0.994, 0.998, respectively) and per 1%‐point decrease in HbA 1c (HR 0.875 95% CI 0.866, 0.884 and 0.872 95% CI 0.862, 0.883). Results were consistent across all subgroups. Reductions in BMI and HbA 1c were associated with reduced risk of retinopathy, neuropathy, CKD, and PAD. Reductions in HbA 1c ‐only were associated with reduced risk of MI and stroke. Conclusions A reduction in BMI and HbA 1c by intentional weight loss, independently and concomitantly, was associated with a reduced risk of microvascular and macrovascular complications in people with obesity and T2D.
Jain et al. (2025) studied this question.