Intentional weight loss was associated with a reduced risk of vascular complications in adults with obesity and type 2 diabetes mellitus (T2DM). The population-based cohort study, published in Diabetes, Obesity and Metabolism, evaluated the relationship between changes in body weight, glycemic control, and long-term vascular outcomes.

The analysis used data from the Clinical Practice Research Datalink (CPRD) Aurum database between 2006 and 2022. Adults with obesity, defined as BMI ≥30 kg/m², and T2D were included. Incidence of microvascular complications, including retinopathy, neuropathy, and CKD, and macrovascular events, including myocardial infarction (MI), PAD, and stroke, was assessed following a four-year intentional weight loss period. Cox proportional hazards models accounted for changes in glycemic control.

The cohort included 100,507 individuals with a mean age of 53.3 years, and 58% were male. Mean relative BMI reduction was −2.2% (standard deviation [SD] 9.1%), and mean absolute change in HbA1c was 0.0% (SD 1.9%). Each 1% reduction in BMI was associated with a lower risk of composite microvascular complications (HR 0.990; 95% confidence interval [CI] 0.988-0.992) and macrovascular complications (HR 0.996; 95% CI 0.994-0.998). Each 1%-point reduction in HbA1c was associated with lower microvascular (HR 0.875; 95% CI 0.866–0.884) and macrovascular risk (HR 0.872; 95% CI 0.862-0.883).

Reductions in BMI and HbA1c were associated with lower risk of retinopathy, neuropathy, CKD, and PAD. Reductions in HbA1c alone were associated with lower risk of MI and stroke. Findings were consistent across subgroups.

These results show that intentional reductions in BMI and HbA1c were independently and jointly associated with lower microvascular and macrovascular complication risk in adults with obesity and T2D.