J Clin Endocrinol Metab. 2021 Oct 1:dgab714. doi: 10.1210/clinem/dgab714. Online ahead of print.
ABSTRACT
CONTEXT: Some studies have suggested that patients with type 2 diabetes mellitus (T2DM) concomitant with obesity have better clinical outcomes than normal-weight patients with T2DM.
OBJECTIVE: We evaluated associations among obesity, cardiovascular disease (CVD) events, and mortality in elderly patients with T2DM without CVD.
DESIGN: Retrospective observational study between 2009 and 2017, with a mean follow-up of 7.26 years.
SETTING: Nationwide (Korea).
PARTICIPANTS: This study included 249,903 elderly (≥65 years) patients with T2DM and no pre-existing CVD using the Korean National Health Information Database.
MAIN OUTCOME MEASURES: We categorized subjects according to body mass index (BMI) and waist circumference (WC) and analyzed a composite of stroke, myocardial infarction, and all-cause death using Cox proportional hazards regression analysis, adjusting for baseline covariates.
RESULTS: The incidence rate of composite primary outcomes was 30.95/1,000 person-years. The primary outcome risk had an L-shaped and a U-shaped association with BMI and WC, respectively. In the multivariable Cox proportional hazard models, the risk of primary composite outcomes in the highest BMI group (≥30 kg/m 2; hazards ratio [HR]=0.824, 95% confidence interval [CI]: 0.794-0.855) was lower than in the normal BMI group (≥18.5 and <23 kg/m 2). Conversely, that in the highest WC group (≥100 cm/≥95 cm; men/women; HR=1.434, 95% CI: 1.384‒1.486) was higher than in the normal WC group (<90 cm/<85 cm; men/women).
CONCLUSION: Our study with elderly patients with diabetes results suggest that while BMI is an inadequate risk indicator for outcomes related to obesity, WC is a suitable alternative.
PMID:34597374 | DOI:10.1210/clinem/dgab714
