Weight Loss Strategies Associated With Type 2 Diabetes Duration: A Population‐Based Optimal Intervention Window From the NHANES

BACKGROUND: Obesity is the most important risk factor in the development and progression of type 2 diabetes. Its tight link to impaired glycemic control highlights the importance of effective weight loss actions (WLAs). Population-based studies investigating associations between type 2 diabetes duration and the odds for undertaking WLAs are scarce. Some studies showed that individuals with incident type 2 diabetes reported at least minimal changes in physical activity and diet, whereas others suggested that lifestyle modifications are generally short-lived and decrease with a longer diabetes duration. METHODS: Using cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES), we hypothesized that the odds for undertaking self-reported WLAs within the last 12 months would decrease with a longer diabetes duration. Multivariable logistic regression models with restricted cubic splines were used to estimate marginal predicted probabilities for undertaking WLAs in 2118 participants with type 2 diabetes. Frequently reported WLAs were analyzed. RESULTS: Results suggested a nonlinear relationship between the time elapsed since diagnosis and the odds for taking WLAs. The marginal predicted probability for taking WLAs was highest in the first year after diagnosis, e.g., 0.57 (95% CI: 0.50-0.65). Probabilities fell thereafter and dropped to 0.46 after 7 years (95% CI: 0.42-0.50). The time window from three to 6 years after diagnosis was identified as a potentially important intervention window, as marginal predicted probabilities dropped by 0.02 (95% CI: -0.38 to -0.001) for each additional year after diagnosis (p = 0.042). Eating less to lose weight and exercising more were the most commonly reported WLAs, with 68.78% and 45.73%, respectively. Time elapsed since diagnosis was associated with the number of WLAs taken. CONCLUSION: Results suggest a significant decrease of WLAs from 3 to 6 years after the diabetes diagnosis, which population-based weight loss strategies should take into account. Early WLAs are crucial before motivation decreases further.