The Association Between BMI Measured Within a Year After Diagnosis of Type 2 Diabetes and Mortality
- Jennifer Logue, MD1⇓,
- Jeremy J. Walker, PHD2,
- Graham Leese, MD3,
- Robert Lindsay, PHD1,
- John McKnight, MD4,
- Andrew Morris, MD3,
- Sam Philip, MD5,
- Sarah Wild, FRCP2,
- Naveed Sattar, FRCP1 and
- on behalf of The Scottish Diabetes Research Network Epidemiology Group*
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- 2Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
- 3School of Medicine, University of Dundee, Dundee, United Kingdom
- 4Western General Hospital, Edinburgh, United Kingdom
- 5Aberdeen Royal Infirmary, Aberdeen, United Kingdom
- Corresponding author: Jennifer Logue,
OBJECTIVE To describe the association of BMI with mortality in patients diagnosed with type 2 diabetes.
RESEARCH DESIGN AND METHODS Using records of 106,640 patients in Scotland, we investigated the association between BMI recorded around the diagnosis of type 2 diabetes mellitus (T2DM) and mortality using Cox proportional hazards regression adjusted for age and smoking status, with BMI 25 to <30 kg/m2 as a referent group. Deaths within 2 years of BMI determination were excluded. Mean follow-up to death or the end of 2007 was 4.7 years.
RESULTS A total of 9,631 deaths occurred between 2001 and 2007. Compared with reference group, mortality risk was higher in patients with BMI 20 to <25 kg/m2 (-HR 1.22 [95% CI 1.13–1.32] in men, 1.32 [1.22–1.44] in women) and patients with BMI ≥35 kg/m2 (for example, 1.70 [1.24–2.34] in men and 1.81 [1.46–2.24]) in women for BMI 45 to <50 kg/m2). Vascular mortality was higher for each 5-kg/m2 increase in BMI >30 kg/m2 by 24% (15–35%) in men and 23% (14–32%) in women, but was lower below this threshold. The results were similar after further adjustment for HbA1c, year of diagnosis, lipids, blood pressure, and socioeconomic status.
CONCLUSIONS Patients categorized 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. Whether weight-loss interventions reduce mortality in all T2DM patients requires study.
↵* A complete list of the Scottish Diabetes Reasearch Network Epidemiology Group can be found in the Supplementary Data online.
- Received May 15, 2012.
- Accepted September 9, 2012.
- © 2012 by the American Diabetes Association.
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