研究目的：糖尿病之發生率隨著年齡而上升，因此糖尿病為老化社會中不可忽視之議題。在許多影響糖尿病發生的因素當中，過重與肥胖為重要之危險因子。然而將會發展糖尿病之中老年人，其體重變化如何有異於一般不會發展出糖尿病之中老年人，尚缺少此方面的實證之研究。本研究目的為描繪中老年人長期的體重變化軌跡，並比較得到糖尿病者與未發病者的不同，此外，我們亦考慮性別及不同體重對於上述關係之影響。研究方法：本研究資料來源為1989-2007年「台灣中老年身心社會生活狀況長期追蹤調查」。研究對象為在首次訪查後開始追蹤，直到2007年才發生糖尿病之樣本(平均首次訪查年齡：58.24歲)，此外亦加入同一追蹤期間內，皆未發生糖尿病之相同年齡者為參考組(平均首次訪查年齡：58.42歲)。運用階層線性模型，估計在此18年期間內各年度的BMI的變化狀況，以比較發生糖尿病者在發病前BMI水平及變化與一般人是否有顯著差異。結果：在18年的追蹤中，一般不會發生糖尿病的中老年人，隨著年齡增加BMI軌跡呈現緩慢上升且上升速度逐漸趨緩的趨勢(βtime=0.08，p<0.001；βtime2=-0.002，p=0.0016)。而會發展出糖尿病者，不但有較高的BMI(βdiabetes =1.294，p=0.0064)，且一開始的BMI上升速度較不會發病者快，之後逐漸趨緩，但在接近自我報告有糖尿病前6.5年時，BMI開始轉為下降之趨勢(βdiabetes*time=0.15，p=0.0327；βdiabetes*time2=-0.008，p=0.0065)。結論：長期體重上升較快可能與未來發生糖尿病的風險有正相關，但若相較於同年齡者，體重在較年輕時有更快速的上升，且後續出現下降的情況，需注意是否為未被診斷糖尿病的訊號，並進一步做抽血檢測或是給予適當的介入。

Objective: Little is known about weight changes preceding diagnosis of diabetes in middle-aged and older adults. We examine long-term trajectories in body mass index (BMI) of those who do and do not develop diabetes. Study Design and Setting: This study utilized retrospective cohort study design with participants aged 50+ from the Taiwan Longitudinal Study of Aging (TLSA, 1989-2007). Individuals who developed diabetes in 2007 (n=200) were compared to adults without diabetes throughout the observational period (n=3,576). Multilevel modeling was used to examine annual levels and rates of change in BMI before diabetes. Results: We found an overall trend of increasing BMI (βtime=0.08, p<.001), and the trend slowed as the participants aged (βtime2= -0.002, p<.001). Participants who developed diabetes exhibit higher BMI scores (βdiabetes =1.294, p<.01) and a faster rate of weight gain (βdiabetes*time=0.15, p<0.05) until approximately 6.5 years before physician-diagnosed diabetes. Diabetes associated with the higher level of BMI was especially evident in women; and the faster rate of weight gain was especially prominent in men or individuals with BMI≥24. These results has controlled for time-varying comorbidities and behavioral factors. Conclusions: Our study support that diabetes is associated with a faster rate of weight gain, even in middle-aged and older adults. The finding that middle-aged and older adults who develop diabetes experience an unplanned weight loss prior to self-reported diagnosis has practical implications that unplanned weight loss may be an alarm for under-diagnosed diabetes or a precursor to developing diabetes.

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