Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease

Thomas, G., Khunti, K., Curcin, V., Molokhia, M., Millett, C., Majeed, A. and Paul, S. (2014) Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease. Diabetes Obesity and Metabolism, 16 4: 317-325. doi:10.1111/dom.12217

Author Thomas, G.
Khunti, K.
Curcin, V.
Molokhia, M.
Millett, C.
Majeed, A.
Paul, S.
Title Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease
Journal name Diabetes Obesity and Metabolism   Check publisher's open access policy
ISSN 1462-8902
Publication date 2014-04-01
Sub-type Article (original research)
DOI 10.1111/dom.12217
Volume 16
Issue 4
Start page 317
End page 325
Total pages 9
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell
Language eng
Formatted abstract
Aim: To address the debate on 'obesity paradox' in patients with type 2 diabetes mellitus (T2DM) by evaluating the cardiovascular and mortality risks associated with normal and overweight patients compared to obese at diagnosis of diabetes, separately for patients with and without cardiovascular disease (CVD) before diagnosis.

Methods: A retrospective study with two study cohorts with/without prior CVD (n=10237/37272) with complete measures of body mass index (BMI) at diagnosis of T2DM from UK General Practice Research Database. Primary outcomes were long-term risks of cardiovascular events (CVEs) and all-cause mortality in patients with normal weight, overweight and obesity at diagnosis.

Results: The mortality rates per 1000 person-years in normal weight, overweight and obese patients among patients without prior CVD were 13.1, 8.6 and 6.0, respectively, during 5years of median follow-up. For patients with prior CVD, these estimates were 30.1, 21.1 and 15.5, respectively. Among patients without and with prior CVD, normal weight patients had 47% (hazard ratio, HR CI: 1.29, 1.69) and 30% (HR CI: 1.11, 1.53) increased mortality risk respectively compared to obese patients. In the cohort without prior CVD, compared to obese patients, those with normal body weight did not have increased CVE risk. Interactions between age, HbA1c and BMI at diagnosis were observed in both cohorts.

Conclusions: Adults with normal weight at the diagnosis of T2DM have significantly higher mortality risk compared to those who are obese, with significant interactions between age, BMI and HbA1c. Elevated cardiovascular risk was not observed in normal weight patients without prior CVD.
Keyword Cardiovascular disease
Observational study
Primary care
Type 2 diabetes
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
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Created: Mon, 18 Nov 2013, 23:49:41 EST by Dr Anna D MacDonald (nee Holmes) on behalf of School of Public Health