Association of weight status with mortality in adults with incident diabetes

Carnethon MR, De Chavez PJ, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308 (6):581-590.  

Carnethon and colleagues analyzed data from five clinical trials to compare mortality rates among subjects who were normal weight with subjects who were overweight/obese at the time of incident adult-onset diabetes.

The study included 2,625 subjects (men and women aged >40 years who developed incident diabetes) from the following trials:

  • Atherosclerosis Risk in Communities (ARIC)
  • Cardiovascular Health Study (CHS)
  • Coronary Artery Risk Development in Young Adults (CARDIA)
  • Framingham Offspring Study (FOS)
  • Multi-Ethnic Study of Atherosclerosis (MESA)

Diabetes was determined as either fasting glucose ≥126 mg/dL or reported new use of oral hypoglycemic medications or insulin at follow-up examinations. Incident diabetes was determined among subjects who were free from diabetes at baseline and met one of the above criteria.

Obesity categories were defined as follows: normal weight, body mass index (BMI) 18.5-24.9 kg/m2; overweight, BMI 25-29.9 kg/m2; and obese, BMI ≥30 kg/m2.

Total, cardiovascular (CV; myocardial infarction, stroke), and non- CV mortality were the main outcome measures.

Results:
Among the trials analyzed, there were 449 total deaths during follow-up (18 causes of death were not classified).

  • Death from CV cause: 178 deaths (6.8%)
  • Death from non-CV cause: 253 deaths (10.4%)

Across cohorts, 293 subjects (11.2%) had normal-weight diabetes. Normal-weight subjects had significantly higher total and non-CV mortality vs those who were overweight/obese.

  • Normal-weight subjects (rate per 10,000 person-years):
    • Total mortality: 284.4
    • CV mortality: 99.8
    • Non-CV mortality: 198.1
     
  • Overweight/obese subjects (rate per 10,000 person-years):
    • Total mortality: 152.1
    • CV mortality: 67.8
    • Non-CV mortality: 87.9
     

After adjustment for covariates (age, race, sex, education, waist circumference, total cholesterol, HDL-C, systolic blood pressure, and smoking), normal-weight subjects with diabetes had

  • Significantly elevated total and non-CV mortality that was consistent across cohorts, although not always statistically significant: total mortality, hazard ratio (HR), 2.08 (95% confidence interval [CI], 1.52-2.85); CV mortality, HR, 1.52 (95% CI, 0.89-2.58); non-CV mortality, HR 2.32 (1.55-3.48).
  • Higher mortality from all causes across sex, age, race, smoking subgroups vs obese/overweight subjects.

 

October 2012  

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Related content: 

Pooled Analysis: Mortality Among Normal and Overweight/Obese Subjects with Diabetes  

Pooled Analysis: Mortality Rates Among Normal and Overweight/Obese Subjects with Diabetes  

Pooled Analysis: Mortality Higher in Normal-Weight Subjects with Diabetes  

Pooled Analysis: Mortality After Covariate Adjustment Among Normal-Weight Vs Overweight/Obese Subjects with Diabetes  

 

Last Modified: 11/15/2013