The effects of intensive glycaemic control on body composition in patients with type 2 diabetes

SUMMARY Aim  To examine the effects of improved glycaemic control over 20 weeks on the type and distribution of weight change in patients with type 2 diabetes who at baseline have poor glycaemic control. Methods  Forty-three patients with type 2 diabetes and HbA1c > 8.9% were randomised to either intensive glycaemic control (IC) n = 21 or usual glycaemic control (UC) n = 22 for 20 weeks. Dual energy X-ray absorptiometry was used to assess the type and distribution of weight change during the study. Results  After 20 weeks HbA1c was significantly lower in patients randomised to IC than UC (HbA1c IC 8.02 ± 0.25% vs. UC 10.23 ± 0.23%, p < 0.0001). In the IC group weight increased by 3.2 ± 0.8 kg after 20 weeks (fat-free mass increased by 1.8 ± 0.3 kg) compared to 0.02 ± 0.70 kg in UC (p = 0.003). The gain in total body fat mass comprised trunk fat mass (IC 0.94 ± 0.5 kg vs. UC 0.04 ± 0.4 kg, p = 0.18) and peripheral fat mass (total body fat – trunk fat) (IC 0.71 ± 0.32 kg vs. UC −0.21 ± 0.28 kg, p = 0.04). Blood pressure and serum lipid concentrations did not change over time in either group. Conclusions  Intensive glycaemic control was associated with weight gain which was distributed in similar proportions between the central and peripheral regions and consisted of similar proportions of fat and fat-free mass. Blood pressure and serum lipid concentrations were not adversely affected.