Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
J Clin Endocrinol Metab. 2022 Jan 18;107(2):e515-e527. doi: 10.1210/clinem/dgab714.
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.
We evaluated associations among obesity, cardiovascular disease (CVD) events, and mortality in elderly patients with T2DM without CVD.
This retrospective observational study from 2009 to 2017, with a mean follow-up of 7.26 years, included 249 903 elderly (≥ 65 years) patients with T2DM and no preexisting CVD from the Korean National Health Information Database. 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.
The incidence rate of composite primary outcomes was 30.95/1000 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/m2; hazard ratio [HR] = 0.824; 95% CI, 0.794-0.855) was lower than in the normal BMI group (≥ 18.5 and < 23 kg/m2). 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).
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.
一些研究表明，伴有肥胖的 2 型糖尿病（T2DM）患者的临床结局优于体重正常的 T2DM 患者。
我们评估了无心血管疾病（CVD）的老年 T2DM 患者中肥胖、CVD 事件和死亡率之间的关联。
这是一项回顾性观察性研究，从 2009 年到 2017 年，平均随访 7.26 年，纳入了来自韩国国家健康信息数据库的 249903 名无既往 CVD 的老年（≥65 岁）T2DM 患者。我们根据体重指数（BMI）和腰围（WC）对患者进行分类，并使用 Cox 比例风险回归分析来分析卒中、心肌梗死和全因死亡的复合终点，调整了基线协变量。
复合主要结局的发生率为 30.95/1000 人年。主要结局的风险与 BMI 和 WC 分别呈 L 形和 U 形关系。在多变量 Cox 比例风险模型中，最高 BMI 组（≥30kg/m2；风险比[HR]＝0.824；95%置信区间，0.794-0.855）的主要复合结局风险低于正常 BMI 组（≥18.5 和<23kg/m2）。相反，最高 WC 组（≥100cm/≥95cm；男性/女性；HR＝1.434；95%置信区间，1.384-1.486）的风险高于正常 WC 组（<90cm/<85cm；男性/女性）。
我们对老年糖尿病患者的研究结果表明，尽管 BMI 是肥胖相关结局的一个不充分的风险指标，但 WC 是一个合适的替代指标。
