Determinants of weight gain in the Action to Control Cardiovascular Risk in Diabetes trial

Fonseca V McDuffie R, Calles J, et al; for the ACCORD Study Group. Determinants of weight gain in the Action to Control Cardiovascular Risk in Diabetes trial. Diabetes Care. 2013;36(8):2162-2168.


Weight gain often occurs as a result of intensive type 2 diabetes treatment. This post-hoc analysis of 8,929 ACCORD1 (Action to Control Cardiovascular Risk in Diabetes) participants found greater weight gain over at least 2 years among patients assigned intensive therapy compared with patients who received standard therapy to control glycemia. These data were used to identify determinants of weight gain associated with intensive therapy. (Click here for slide) 


Significantly more weight gain was noted in the intensive glycemia arm of ACCORD than in the standard glycemia arm. At the end of year 2, the average weight gain was 3.0 (±7.0) kg in the intensive arm.

Baseline characteristics associated with increased weight at 2 years in the intensive and standard glycemic control arms in ACCORD included: (Click here for slide)  

  • Younger age
  • Male gender
  • Asian race
  • No smoking history
  • Baseline A1C >8.5%
  • Baseline body mass index (BMI) 25-35 kg/m2 
  • High waist circumference
  • Baseline insulin use
  • Baseline metformin use 

In the intensive and standard glycemia arms, participants with the highest baseline A1C gained weight as A1C levels improved. Among participants whose baseline A1C was <7.8%, weight loss occurred as A1C improved in both treatment groups. In the intensive group: (Click here for slide)  

  • The relationship between change in A1C and change in weight was statistically significant (P<0.001) with a decrease in A1C associated with weight gain
  • Decreased A1C and weight gain occurred among 59% of participants; decreased A1C and weight loss occurred in 28.8% of participants

Overall change in weight due to medication use accounted for <15% of the variability in weight gain. Insulin, thiazolidinediones (TZDs), and metformin conferred the most influence on weight gain—which was more pronounced in the intensive group. (Click here for slide) 

Weight change at  
2 years 
Insulin or TZD   
No prior use (n=95) -2.9 kg (avg)
Initiated insulin or TZD during trial +4.6 to 5.3 kg
Metformin at baseline, assigned intensive, initiated insulin and TZD +4.9 kg (mean)
No prior use (n=244) +2.7 kg (mean)
Metformin at baseline and continued throughout trial (n=2,784) +1.9 kg (avg)
Metformin added during trial (n=1,588) +0.7 kg (avg)


1. Gerstein HC, Miller ME, Byington RP, et al; for the ACCORD Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-2559.

Related content: 

Overview: Effects of intensive glucose lowering in type 2 diabetes 

Slide: ACCORD: Study Design 



The pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

May 2013 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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