BMI and mortality in patients with new-onset type 2 diabetes: a comparison with age- and sex-matched control subjects from the general population

Edqvist, J., Rawshani, A., Adiels, M., Björck, L., Lind, M., Svensson, A.-M., Gudbjörnsdottir, S., Sattar, N. and Rosengren, A. (2018) BMI and mortality in patients with new-onset type 2 diabetes: a comparison with age- and sex-matched control subjects from the general population. Diabetes Care, 41(3), pp. 458-493. (doi: 10.2337/dc17-1309) (PMID:29298801)

Abstract

Objective: Type 2 diabetes is strongly associated with obesity, but the mortality risk related to elevated body weight in people with type 2 diabetes compared with people without diabetes has not been established. Research Design and Methods: We prospectively assessed short- and long-term mortality in people with type 2 diabetes with a recorded diabetes duration ≤5 years identified from the Swedish National Diabetes Registry between 1998 and 2012 and five age- and sex-matched control subjects per study participant from the general population. Results: Over a median follow-up of 5.5 years, there were 17,546 deaths among 149,345 patients with type 2 diabetes (mean age 59.6 years [40% women]) and 68,429 deaths among 743,907 matched control subjects. Short-term all-cause mortality risk (≤5 years) displayed a U-shaped relationship with BMI, with hazard ratios (HRs) ranging from 0.81 (95% CI 0.75-0.88) among patients with diabetes and BMI 30 to <35 kg/m2 to 1.37 (95% CI 1.11-1.71) with BMI ≥40 kg/m2 compared with control subjects after multiple adjustments. Long-term, all weight categories showed increased mortality, with a nadir at BMI 25 to <30 kg/m2 and a stepwise increase up to HR 2.00 (95% CI 1.58-2.54) among patients with BMI ≥40 kg/m2, that was more pronounced in patients <65 years old. Conclusions: Our findings suggest that the apparent paradoxical findings in other studies in this area may have been affected by reverse causality. Long-term, overweight (BMI 25 to <30 kg/m2) patients with type 2 diabetes had low excess mortality risk compared with control subjects, whereas risk in those with BMI ≥40 kg/m2 was substantially increased.

• Item Type: Articles
• Additional Information: This study received grants from the Swedish State under the Agreement Concerning Research and Education of Doctors (ALFGBG427301), the Swedish Heart and Lung Foundation (2015-0438), the Swedish Research Council (2013-4236), the Swedish Diabetes Foundation (2013-5187), and the Swedish Council for Health, Working Life and Welfare (FORTE) (2013-0325). The Swedish Diabetes Association and the Swedish Society of Diabetology support the NDR. The Swedish Association of Local Authorities and Regions funds the NDR.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed
• Authors: Edqvist, J., Rawshani, A., Adiels, M., Björck, L., Lind, M., Svensson, A.-M., Gudbjörnsdottir, S., Sattar, N., and Rosengren, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Diabetes Care
• Publisher: American Diabetes Association
• ISSN: 0149-5992
• ISSN (Online): 1935-5548
• Published Online: 03 January 2018
• Copyright Holders: Copyright © 2018 The American Diabetes Association
• First Published: First published in Diabetes Care 41(3):458-493
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher