BMI trajectories were identified in 3,539 adults with type 2 diabetes (T2D) diagnosed in North Karelia (2011–2014) and followed through 2024, examining associations with lab monitoring, medication use, comorbidities, and healthcare utilization across trajectory groups.
Three BMI trajectories emerged: stable (77.7%), increasing (14.6%), and decreasing (7.7%). The decreasing group had the lowest HbA1c and LDL monitoring rates and the highest healthcare utilization, and was marked by higher rates of dementia and cardiovascular/pulmonary disease; the increasing group accumulated more chronic kidney disease, obesity-related diagnoses, sleep disorders, and chronic lower respiratory disease. GLP-1 agonist use peaked in the decreasing class in 2015 and in the increasing class in 2024.
Single Finnish region (North Karelia) limits generalizability. Observational design prevents causal inference. No data on intentional vs. unintentional weight loss in the decreasing class, which is clinically important.
Patients with T2D who are losing weight warrant closer metabolic monitoring and comorbidity screening—not less—as this group showed the lowest lab measurement activity despite the highest healthcare use. Clinicians should tailor comorbidity surveillance by BMI trajectory, watching for kidney disease and sleep disorders in those gaining weight.
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