328-OR: Degree of Glycemic Improvement in Patients with Diabetes Enrolled in Real-World Intensive Lifestyle Intervention in Relation to Baseline A1C: Five-Year Longitudinal Observation

We previously reported that weight loss in patients with diabetes and obesity through real-world Intensive Lifestyle Intervention (ILI) is associated with significantly lower A1C for up to 5 years. However, it is unclear if baseline A1C has any impact on the magnitude of glycemic improvement in this population. Over 5 years, we evaluated a cohort of 129 patients with diabetes and obesity (90% type 2 diabetes, 67% female, mean age 53±10 years, diabetes duration 10±9 years, body weight 110±19 Kg, BMI 38±5.3 Kg/m²) enrolled in a 12-week ILI program. According to baseline A1C, we divided participants into group A with A1C<7.5% (73 patients, 56.6%, mean A1C 6.5±0.5%), group B with A1C 7.5-9% (41 patients, 31.8%, mean A1C 8.1±0.4%), and group C with A1C >9% (15 patients, 11.6%, mean A1C 9.8±0.8%). Compared to baseline, body weight decreased at 5 years by 6.6 Kg, 9.6 Kg, and 8.3 Kg in groups A, B, and C, respectively (p<0.05 for all). A1C in group A decreased by 0.5±0.9% at 12 weeks (p<0.0001) but increased over the following 5 years by 0.1±0.1%, 1.2±0.9%, 0.3±0.1%, 0.4±0.1%, and 0.6±0.2%, respectively (p<0.01 at 5 years compared to baseline). A1C in group B decreased by 1.1±0.2% at 12 weeks (p<0.0001), was maintained significantly lower at 1 year by -0.5±0.2% (p<0.001), rose to baseline at 3 years and maintained at the same level for up to 5 years. A1C in group C decreased by 2.4%±0.3% at 12 weeks (p<0.0001), was maintained significantly lower at 1 year by 0.9±0.5% (p<0.001), also rose to baseline at 3 years, and was maintained at the same level for up to 5 years (p<0.05 between groups at 5 years). We conclude that patients with diabetes and obesity who enroll in real-world ILI with baseline A1C ≥7.5% are more likely to maintain improvements in A1C for at least 3 years before returning to baseline values compared to patients with baseline A1C<7.5%. This finding may help clinicians use baseline A1C to set realistic long-term expectations for patients considering ILI.