Wang Zhiting, Lavikainen Piia, Wikström Katja, Laatikainen Tiina
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Clin Epidemiol. 2024 Mar 29;16:203-212. doi: 10.2147/CLEP.S450455. eCollection 2024.
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).
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.
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.
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.
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及全因死亡率之间的关联。
在这项队列研究中，使用了芬兰北卡累利阿13个市镇公共初级和专科医疗服务机构的电子健康记录。本研究共纳入了889例在2011年或2012年新诊断为T2D的成年人（基线平均年龄62.0岁）。从T2D诊断到2014年的个体BMI轨迹通过生长混合模型（GMM）进行估计和分组。使用Cox回归模型估计2015年至2022年期间各BMI轨迹组微血管并发症、大血管并发症、任何糖尿病并发症及全因死亡率的风险比（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（n = 774，87.1%）、“下降”组（n = 87，9.8%）和“上升”组（n = 28，3.1%）。在中位随访8年期间，有119例（13.3%）患者发生微血管并发症，187例（21.0%）发生大血管并发症，258例（29.0%）发生任何糖尿病并发症，180例（20.2%）死亡。与“稳定”BMI相比，“上升”BMI与微血管并发症风险增加相关（HR = 2.88，95% CI：1.32至6.28）、大血管并发症风险增加相关（HR = 2.52，95% CI：1.17至5.43）以及任何糖尿病并发症风险增加相关（HR = 2.21，95% CI：1.16至4.20）。与“稳定”BMI相比，“下降”BMI与全因死亡率风险增加相关（HR = 1.90，95% CI：1.14至3.15）。
我们的研究结果强调了对T2D患者持续进行BMI监测和体重管理的重要性。量身定制的治疗对于有效预防体重增加和降低糖尿病并发症风险至关重要。
