To address the heterogeneity of type 2 diabetes, we characterised patterns of change in body mass index BMI and other cardiometabolic risk factors before type 2 diabetes diagnosis. White men and women, initially free of diabetes, were followed with 5-yearly clinical examinations from for a median of Type 2 diabetes developed in 1, person-examinations and 6, remained free of diabetes during follow-up 14, person-examinations.
Latent class trajectory analysis of incident diabetes cases was used to identify patterns of pre-disease BMI. Associated trajectories of cardiometabolic risk factors were studied using adjusted mixed-effects models. Three patterns of BMI changes were identified.
They experienced slightly worsening of beta cell function and insulin sensitivity from 5 years prior to diagnosis. Linear increases in blood pressure and an exponential increase in insulin resistance a few years before diagnosis accompanied the weight gain.
They experienced an initial beta cell compensation followed by loss of beta cell function, whereas insulin sensitivity was relatively stable.
Since the generalizability of these findings is limited, the results need confirmation in other study populations. While these results should be verified independently, the great majority of patients had modest weight gain prior to diagnosis.
These results suggest that strategies focusing on small weight reductions for the entire population may be more beneficial than predominantly focusing on weight loss for high-risk individuals.