Influence of Intensive Diabetes Treatment on Body Weight and Composition of Adults With Type 1 Diabetes in the Diabetes Control and Complications Trial

Influence of Intensive Diabetes Treatment on Body Weight and Composition of Adults With Type 1 Diabetes in the Diabetes Control and Complications Trial The Diabetes Control and Complications Trial Research Group A complete listing of the Diabetes Control and Complications Trial Research Group is available in The Diabetes Control and Complications Trial Research Group: The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin-dependent diabetes mellitus. Arch Opthalmol 113:36–51, 1995. Abstract OBJECTIVE —To examine the differential effects of intensive and conventional diabetes therapy on weight gain and body composition in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS —Between 1982 and 1989, 1,246 adults (aged 18–39 years) in the Diabetes Control and Complications Trial were randomly assigned to either conventional therapy (1–2 injections of insulin per day) or intensive therapy (multiple daily injections or continuous subcutaneous infusion with frequent blood-glucose testing). Height and weight were measured at baseline and at annual visits for an average of 6 years (range 3–9). Body composition was assessed cross-sectionally with bioelectrical impedance analysis during 1992, at which time waist and hip circumferences were measured. RESULTS —Intensively treated patients gained an average of 4.75 kg more than their conventionally treated counterparts ( P < 0.0001). This represented excess increases in BMI of 1.5 kg/m 2 among men and 1.8 kg/m 2 among women. Growth-curve analysis showed that weight gain was most rapid during the first year of therapy. Intensive therapy patients were also more likely to become overweight (BMI ≥27.8 kg/m 2 for men, ≥27.3 kg/m 2 for women) or experience major weight gain (BMI increased ≥5 kg/m 2 ). Waist-to-hip ratios, however, did not differ between treatment groups. Major weight gain was associated with higher percentages of body fat and greater fat-free mass, but among patients without major weight gain, those receiving intensive therapy had greater fat-free mass with no difference in adiposity. CONCLUSIONS —Intensive therapy for type 1 diabetes produces substantial excess weight gain compared with conventional therapy. However, the additional weight appears to include lean tissue as well as fat. BIA, bioelectrical body impedance analysis DCCT, Diabetes Control and Complications Trial NCEP, National Cholesterol Education Program WHR, waist-to-hip ratio Footnotes Address reprint requests to the DCCT Research Group, Box NDIC/DCCT, Bethesda, MD 20892. Address correspondence to David M. Nathan, MD, Diabetes Unit–Bulfinch 408, Massachusetts General Hospital, Boston, MA 02114. E-mail: nathan{at}gcrc.mgh.harvard.edu . Received for publication 19 December 2000 and accepted in revised form 27 June 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.