Assessment of a Multidisciplinary Intervention in Patients With BMI ≥35 kg/m2 and Recently Diagnosed Type 2 Diabetes

Context: Patients with a body mass index (BMI) >= 35 kg/m(2) have lower benefits with intensive treatments and metabolic control goals are more difficult to reach. Objective: Evaluate the effect of a comprehensive care program in patients with a BMI >= 35 kg/m(2). Design: Prospective cohort study. Setting: Comprehensive Care Center in a National Institute of Health. Patients: Patients with type 2 diabetes, <= 5 years of diagnosis, without disabling complications, nonsmokers, and a BMI <45 kg/m(2). Interventions: Exercise and nutritional interventions are modified for patients with a higher BMI to achieve metabolic control. Main Outcome Measures: Main outcome is achievement of treatment goals defined as HbA1c <7%, low-density lipoprotein cholesterol (LDL-c) <100 mg/dL, and blood pressure <130/80 mm Hg. Secondary measures were the percentage of patients achieving three metabolic goals. Results: A total of 587 patients with annual evaluation were included. Mean age was 55.3 +/- 9.5 years, 56.6% women, time since diagnosis of 1 year (0 to 5). BMI <35 kg/m(2) group included 521 patients and BMI >= 35 kg/m(2) group included 66 patients. In the BMI >= 35 kg/m(2) group, we observed a greater decrease in weight and fat mass at 3 months compared with <35 kg/m(2) group, but the HbA1c, LDL-c, or blood pressure goals were similar at 3 months and 1 year between groups. Conclusions: Comprehensive interventions are equally effective in patients with recently diagnosed type 2 diabetes with BMI >= 35 kg/m(2) compared with patients with a lower BMI.