Achieving at Least 15% Weight Loss Within 2 Years of Type 2 Diabetes Diagnosis Is Associated With Lower Risks of Macrovascular and Microvascular Complications: A U.K. Cohort Study.

Abstract

This study aimed to evaluate whether achieving a minimum of 15% weight loss early after type 2 diabetes diagnosis was associated with subsequent lower risks of developing macrovascular and microvascular complications. Using U.K. primary care data from Clinical Practice Research Datalink Aurum linked to hospital and mortality data, we conducted a cohort study (2000-2024) of adults with obesity and type 2 diabetes. Individuals with ≥15% weight loss within 2 years of type 2 diabetes diagnosis were propensity score matched 1:4 to control subjects maintaining a stable weight (<2% weight change). Cumulative incidence rates were determined, and time to first macrovascular (myocardial infarction, stroke, angina, peripheral arterial disease) and microvascular (chronic kidney disease, retinopathy, neuropathy) events was analyzed using Cox proportional hazards regression. The matched cohort included 14,496 individuals with ≥15% weight loss and 57,984 control subjects. Compared with control subjects, the weight loss group had significantly lower risk of first macrovascular (hazard ratio 0.86, 95% CI 0.81-0.91) and microvascular (hazard ratio 0.90, 95% CI 0.86-0.94) events. Individually, significantly lower risks were observed for myocardial infarction, angina, chronic kidney disease, and retinopathy. The weight loss group also demonstrated better glycemic and blood pressure levels, despite fewer medications. Achieving ≥15% weight loss early in type 2 diabetes was associated with clinically meaningful lower risks for macro- and microvascular complications and better glycemic control compared with stable weight. These real-world findings support prioritizing early, substantial weight reduction as a core therapeutic strategy to improve glycemic control and prevent end-organ damage.