Clinical implications of intentional weight loss in people living with type 2 diabetes: A real‐world database study

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.