Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients

McEwen, Laura N.; Karter, Andrew J.; Waitzfelder, Beth E.; Crosson, Jesse C.; Marrero, David G.; Mangione, Carol M.; Herman, William H.

doi:10.2337/dc11-2281

Cited by 110 publications

(100 citation statements)

References 12 publications

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“…1). Following detailed assessments, and after the inclusion of three articles identified from manual searches, 21 articles were included in the quantitative analysis (21 studies and 24 unique cohorts; Table 1) [7,8,11,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Study characteristics and the NOS scores are provided in ESM Tables 1-3.…”

Section: Resultsmentioning

confidence: 99%

“…However, evidence on the association between obesity and mortality in patients with diabetes remains inconclusive with some studies reporting an inverse association between obesity (estimated using the conventional Electronic supplementary material The online version of this article (doi:10.1007/s00125-016-4162-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users. measure of BMI) and mortality [4][5][6], some reporting U-shaped associations [7,8], some reporting linear positive associations [9,10], and some reporting no association [11].…”

Section: Introductionmentioning

confidence: 99%

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Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

et al. 2016

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Aims/hypothesis The relationship between BMI and mortality has been extensively investigated in the general population; however, it is less clear in people with type 2 diabetes. We aimed to assess the association of BMI with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Methods We searched electronic databases up to 1 March 2016 for prospective studies reporting associations for three or more BMI groups with all-cause and cardiovascular mortality in individuals with type 2 diabetes mellitus. Study-specific associations between BMI and the most-adjusted RR were estimated using restricted cubic splines and a generalised least squares method before pooling study estimates with a multivariate random-effects meta-analysis. Results We included 21 studies including 24 cohorts, 414,587 participants, 61,889 all-cause and 4470 cardiovascular incident deaths; follow-up ranged from 2.7 to 15.9 years. There was a strong nonlinear relationship between BMI and all-cause mortality in both men and women, with the lowest estimated risk from 31-35 kg/m 2 and 28-31 kg/m 2 (p value for nonlinearity <0.001) respectively. The risk of mortality at higher BMI values increased significantly only in women, whilst lower values were associated with higher mortality in both sexes. Limited data for cardiovascular mortality were available, with a possible inverse linear association with BMI (higher risk for BMI <27 kg/m 2 ). Conclusions/interpretation In type 2 diabetes, BMI is nonlinearly associated with all-cause mortality with lowest risk in the overweight group in both men and women. Further research is needed to clarify the relationship with cardiovascular mortality and assess causality and sex differences.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

et al. 2016

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“…15 Because of the high morbidity, mortality, and cost associated with T2DM, there is a need to develop models to simulate the long-term outcomes and costs of T2DM beyond the time horizon of clinical trials. Because CVD is the leading cause of morbidity and mortality in people with T2DM, 16,17 it is important that any computer model for T2DM incorporate a valid submodel for CHD. Unless that model simulates medication effects and surgical practices explicitly, it will not accurately predict the CVD outcomes observed in clinical studies.…”

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confidence: 99%

The Michigan Model for Coronary Heart Disease in Type 2 Diabetes: Development and Validation

Brändle

Brown

et al. 2015

Diabetes Technology & Therapeutics

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Objectives: The aim of this study was to develop and validate a computer simulation model for coronary heart disease (CHD) in type 2 diabetes mellitus (T2DM) that reflects current medical and surgical treatments. Research Design and Methods: We modified the structure of the CHD submodel in the Michigan Model for Diabetes to allow for revascularization procedures before and after first myocardial infarction, for repeat myocardial infarctions and repeat revascularization procedures, and for congestive heart failure. Transition probabilities that reflect the direct effects of medical and surgical therapies on outcomes were derived from the literature and calibrated to recently published population-based epidemiologic studies and randomized controlled clinical trials. Monte Carlo techniques were used to implement a discrete-state and discrete-time multistate microsimulation model. Performance of the model was assessed using internal and external validation. Simple regression analysis (simulated outcome = b 0 + b 1 · published outcome) was used to evaluate the validation results. Results: For the 21 outcomes in the six studies used for internal validation, R 2 was 0.99, and the slope of the regression line was 0.98. For the 16 outcomes in the five studies used for external validation, R 2 was 0.81, and the slope was 0.84. Conclusions: Our new computer simulation model predicted the progression of CHD in patients with T2DM and will be incorporated into the Michigan Model for Diabetes to assess the cost-effectiveness of alternative strategies to prevent and treat T2DM.

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“…Most previous studies did not exclude patients with a history of CVD and cancer when they assessed the association between BMI and the risk of mortality among individuals with type 2 diabetes. [4][5][6] The analysis by Jackson et al 7 excluded individuals who reported a prior history of cancer and/or coronary heart disease, which can minimize the influence of reverse causation.…”

mentioning

confidence: 99%

“…3,5,7 However, many previous studies had small samples, and thus lacked adequate statistical power when the analysis was limited to those who have never smoked. 4,6 The third methodological concern in some analyses between body weight and mortality is that the physiologic effects of excess fatness, such as hypertension, diabetes, and dyslipidemia, were controlled statistically, thus artificially removing some of the effects of being overweight. Most of the studies assessing the association of BMI and morality risk among individuals with type 2 diabetes have taken this potential over-adjustment for weight-related risk factors into consideration.…”

mentioning

confidence: 99%

Is Mortality Risk Reduced in Overweight or Obese Diabetics?

Heymsfield

2013

J GEN INTERN MED

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D iabetes is considered a 21st century epidemic, affecting approximately 26 million individuals in the U.S. and costing $245 billion. 1 Overweight and obesity are also important public health problems. Two in three US adults are currently classified as overweight (body mass index [BMI] 25.0-29.9 kg/m 2 ) or obese (BMI ≥ 30 kg/m 2 ), and more than one-third of US adults are obese. 2 A sedentary lifestyle and unhealthy dietary habits contribute to obesity 2 and diabetes. About 45-65 % patients with type 2 diabetes are obese in the US. 3 However, the association between BMI and mortality is unclear among patients with type 2 diabetes. To date, studies have reported inverse associations, 3 positive associations, 4 U-shaped associations, 5 or no associations between BMI and mortality 6 among patients with type 2 diabetes. The reasons for the difference in associations across studies are not clear, although the study samples differed at baseline by mean BMI, health status, ethnicity, and duration of diabetes.In this issue of JGIM, Jackson and colleagues 7 assess the association of BMI with the risk of total mortality among 34,805 never smokers (2,035 with diabetes and 32,770 without diabetes) from the 1997-2002 National Health Interview Survey, and show that BMI is positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes. The relationships observed in this study are strong, graded, and independent of smoking, cardiovascular disease (CVD), cancer, and a range of other potential confounders including age, marital status, leisure-time physical activity, alcohol consumption, poor income, and self-reported general health status.The study by Jackson et al. provides important information on the "obesity paradox," which describes the inverse association between excess adiposity as defined by BMI and mortality. Another recent analysis by Carnethon et al. pooled five longitudinal studies and found that patients who are normal weight at the time of incident diabetes have a higher mortality risk than those who are overweight or obese. 3 The authors suggest that "metabolically obese" normal-weight (MONW) diabetics may harbor an underlying illness that predisposes to mortality. 8 Despite having a normal BMI, these individuals have hyperinsulinemia, insulin resistance, and dyslipidemia, all of which predispose to the risk of premature death. 8 Individuals with MONW are becoming more common in the US, with 23.5 % of normal-weight US adults now considered metabolically "abnormal". 9

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Predictors of Mortality Over 8 Years in Type 2 Diabetic Patients

Cited by 110 publications

References 12 publications

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

Nonlinear association of BMI with all-cause and cardiovascular mortality in type 2 diabetes mellitus: a systematic review and meta-analysis of 414,587 participants in prospective studies

The Michigan Model for Coronary Heart Disease in Type 2 Diabetes: Development and Validation

Is Mortality Risk Reduced in Overweight or Obese Diabetics?

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