Clinical Epidemiology (Mar 2024)
Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients
Abstract
Zhiting Wang,1 Piia Lavikainen,2 Katja Wikström,1,3 Tiina Laatikainen1,3,4 1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; 2School of Pharmacy, University of Eastern Finland, Kuopio, Finland; 3Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; 4Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, FinlandCorrespondence: Zhiting Wang, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, Kuopio, 70211, Finland, Tel +358 469589963, Email [email protected]: 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
