Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients

IF 3.4 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Clinical Epidemiology Pub Date : 2024-03-29 DOI:10.2147/clep.s450455

Zhiting Wang, Piia Lavikainen, Katja Wikström, Tiina Laatikainen

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Abstract

Objective: We aimed to assess how longitudinal body mass index (BMI) trajectories are associated with diabetes complications and all-cause mortality in Finnish patients with type 2 diabetes (T2D).
Methods: In this cohort study, electronic health records from public primary and specialized healthcare services in all 13 municipalities of North Karelia, Finland, were utilized. This study included a total of 889 adults with newly diagnosed T2D in 2011 or 2012 (mean age at baseline 62.0 years). Individual BMI trajectories from the T2D diagnosis until 2014 were estimated and grouped by growth mixture modeling (GMM). Hazard ratios (HRs) with 95% confidence intervals (CIs) for microvascular complications, macrovascular complications, any diabetes complications, and all-cause mortality from 2015 to 2022 across BMI trajectory groups were estimated using Cox regression models.
Results: Three distinct BMI trajectory groups were identified using GMM and labeled as follows: “stable” (n = 774, 87.1%), “decreasing” (n = 87, 9.8%), and “increasing” (n = 28, 3.1%). During a median follow-up of 8 years, there were 119 (13.3%) patients with microvascular complications, 187 (21.0%) with macrovascular complications, 258 (29.0%) with any diabetes complications, and 180 (20.2%) deaths. Compared with the “stable” BMI, the “increasing” BMI was associated with an increased risk of microvascular complications (HR = 2.88, 95% CI: 1.32 to 6.28), macrovascular complications (HR = 2.52, 95% CI: 1.17 to 5.43), and any diabetes complications (HR = 2.21, 95% CI: 1.16 to 4.20). The “decreasing” BMI was associated with an increased risk of all-cause mortality (HR = 1.90, 95% CI: 1.14 to 3.15), compared to the “stable” BMI.
Conclusion: Our findings underscore the significance of continuous BMI monitoring and weight management in patients with T2D. Tailored treatments are crucial for efficiently preventing weight gain and reducing the risk of diabetes complications.

Keywords: body mass index trajectory, type 2 diabetes, diabetes complications, all-cause mortality

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芬兰 2 型糖尿病患者的体重指数与糖尿病并发症和全因死亡率的风险轨迹

目的我们旨在评估芬兰2型糖尿病（T2D）患者的纵向体重指数（BMI）轨迹与糖尿病并发症和全因死亡率的关系：在这项队列研究中，利用了芬兰北卡累利阿所有 13 个市的公共初级和专业医疗保健服务机构的电子健康记录。这项研究共纳入了 889 名在 2011 年或 2012 年新诊断出患有 T2D 的成年人（基线时的平均年龄为 62.0 岁）。研究人员通过生长混合模型（GMM）估算并分组了从确诊 T2D 到 2014 年的个体 BMI 轨迹。使用 Cox 回归模型估算了 2015 年至 2022 年各 BMI 轨迹组微血管并发症、大血管并发症、任何糖尿病并发症和全因死亡率的危险比（HRs）及 95% 置信区间（CIs）：使用 GMM 确定了三个不同的 BMI 轨迹组，并标记如下："稳定 "组（774 人，87.1%）、"下降 "组（87 人，9.8%）和 "上升 "组（28 人，3.1%）。在中位随访 8 年期间，有 119 例（13.3%）患者出现微血管并发症，187 例（21.0%）患者出现大血管并发症，258 例（29.0%）患者出现任何糖尿病并发症，180 例（20.2%）患者死亡。与 "稳定 "体重指数相比，"增加 "体重指数与微血管并发症（HR = 2.88，95% CI：1.32 至 6.28）、大血管并发症（HR = 2.52，95% CI：1.17 至 5.43）和任何糖尿病并发症（HR = 2.21，95% CI：1.16 至 4.20）的风险增加有关。与 "稳定 "的体重指数相比，"下降 "的体重指数与全因死亡风险增加有关（HR = 1.90，95% CI：1.14 至 3.15）：我们的研究结果强调了对糖尿病患者进行持续体重指数监测和体重管理的重要性。关键词：体重指数轨迹；2型糖尿病；糖尿病并发症；全因死亡率

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来源期刊

Clinical Epidemiology Medicine-Epidemiology

CiteScore

6.30

自引率

5.10%

发文量

169

审稿时长

16 weeks

期刊介绍： Clinical Epidemiology is an international, peer reviewed, open access journal. Clinical Epidemiology focuses on the application of epidemiological principles and questions relating to patients and clinical care in terms of prevention, diagnosis, prognosis, and treatment. Clinical Epidemiology welcomes papers covering these topics in form of original research and systematic reviews. Clinical Epidemiology has a special interest in international electronic medical patient records and other routine health care data, especially as applied to safety of medical interventions, clinical utility of diagnostic procedures, understanding short- and long-term clinical course of diseases, clinical epidemiological and biostatistical methods, and systematic reviews. When considering submission of a paper utilizing publicly-available data, authors should ensure that such studies add significantly to the body of knowledge and that they use appropriate validated methods for identifying health outcomes. The journal has launched special series describing existing data sources for clinical epidemiology, international health care systems and validation studies of algorithms based on databases and registries.