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BMI, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes: Findings Against an Obesity Paradox

Artikel i vetenskaplig tidskrift
Författare Jon Edqvist
Araz Rawshani
M. Adiels
Lena Björck
Marcus Lind
A. M. Svensson
S. Gudbjornsdottir
N. Sattar
Annika Rosengren
Publicerad i Diabetes Care
Volym 42
Nummer/häfte 7
Sidor 1297-1304
ISSN 0149-5992
Publiceringsår 2019
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 1297-1304
Språk en
Länkar dx.doi.org/10.2337/dc18-1446
Ämnesord excess mortality, glycemic control, heart-failure, overweight, disease, individuals, population, impact, risk, Endocrinology & Metabolism
Ämneskategorier Endokrinologi och diabetes

Sammanfattning

OBJECTIVE Low weight has been associated with increased mortality risks in type 1 diabetes. We aimed to investigate the importance of weight and weight gain/loss in the Swedish population diagnosed with type 1 diabetes. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (n = 26,125; mean age 33.3 years; 45% women) registered in the Swedish National Diabetes Registry from 1998 to 2012 were followed from the first day of study entry. Cox regression was used to calculate risk of death from cardiovascular disease (CVD), major CVD events, hospitalizations for heart failure (HF), and total deaths. RESULTS Population mean BMI in patients with type 1 diabetes increased from 24.7 to 25.7 kg/m(2) from 1998 to 2012. Over a median follow-up of 10.9 years, there were 1,031 deaths (33.2% from CVD), 1,460 major CVD events, and 580 hospitalizations for HF. After exclusion of smokers, patients with poor metabolic control, and patients with a short follow-up time, there was no increased risk for mortality in those with BMI <25 kg/m(2), while BMI >25 kg/m(2) was associated with a minor increase in risk of mortality, major CVD, and HF. In women, associations with BMI were largely absent. Weight gain implied an increased risk of mortality and HF, while weight loss was not associated with higher risk. CONCLUSIONS Risk of major CVD, HF, CVD death, and mortality increased with increasing BMI, with associations more apparent in men than in women. After exclusion of factors associated with reverse causality, there was no evidence of an obesity paradox.

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