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BMI and mortality

High mortality for normal weight/obese T2DM patients

Mortality risk was higher in both male and female patients

Patients with T2DM who are classified as normal weight or obese within a year of initial diabetes diagnosis have variably higher mortality outcomes, compared with the overweight patients.

According to the study results, which were published in the journal Diabetes care, this forms a U-shaped association between BMI and mortality.

The study by researchers from the University of Glasgow, UK, used data from 106,640 patient records to describe the association between BMI recorded at the time of T2DM diagnosis and mortality. Cox proportional hazards regression adjusted for age and smoking status was used, with BMI 25-<30 as a referent group. Deaths within two years of BMI determination were excluded.

The results revealed a total of 9,631 deaths between 2001 and 2007. The researcher report that the mortality risk was higher in both male and female patients with BMI 20 to <25 (-HR 1.22 [95% CI 1.13–1.32] in men, 1.32 [1.22–1.44] in women) and patients with BMI ≥35 (for example, 1.70 [1.24–2.34] in men and 1.81 [1.46–2.24]) in women for BMI 45 to <50), compared with the patients with BMI 25-<30 (the referent group).

In addition, for each 5kg increase in BMI>30, vascular mortality was higher by 24% (15–35%) in men and 23% (14–32%) in women, but was lower below this threshold.

These results were generally similar after adjustment for glycated haemoglobin, year of diagnosis, lipid levels, blood pressure, and the patients’ socioeconomic status.

The investigators concluded that patients categorised as normal weight or obese with T2DM within a year of diagnosis of T2DM exhibit variably higher mortality outcomes compared with the overweight group, confirming a U-shaped association of BMI with mortality.

They noted that previous studies have demonstrated convincingly that all-cause mortality does not increase monotonically with greater BMI but instead follows a U-shaped pattern.

“Further research is needed to investigate the mechanisms of obesity-related mortality risk, potential mechanisms for increased mortality at lower BMI, and also the effect of weight loss interventions on morbidity and mortality in people with T2DM with differing levels of baseline BMI,” the authors write.

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