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Abstract
AimsGiven that BMI correlates with risk of Type 2 diabetes mellitus (T2DM), and that hypertension is a common comorbid condition, we hypothesize that hypertension augments significantly the impact of obesity on T2DM onset.MethodsWe obtained data on T2DM in Kuwaiti natives from Kuwait Health Network Registry. We considered 1339 comorbid individuals with onset of hypertension preceding that of T2DM, and 3496 non-hypertensive individuals but with T2DM. Multiple linear regressions, ANOVA tests, and Cox proportional hazards models were used to quantify the impact of hypertension on correlation of BMI with age at onset and risk of T2DM.ResultsImpact of increasing levels of BMI on age at onset ot T2DM is seen augmented in patients diagnosed with hypertension. We find that the slope of the inverse linear relationship between BMI and onset age of T2DM is much steep in hypertensive patients (−0.69, males and −0.39, females) than in non-hypertensive patients (−0.36, males and −0.17, females). The decline in onset age for an unit increase of BMI is two-fold in males than in females. Upon considering BMI as a categorical variable, we find that while the mean onset age of T2DM in hypertensive patients decreases by as much as 5–12 years in every higher BMI categories, significant decrease in non-hypertensive patients exists only when severely obese. Hazard due to hypertension (against the baseline of non-hypertension and normal weight) increases at least two-fold in every obese category. While males have higher hazard due to hypertension in early adulthood, females have higher hazard in late adulthood.ConclusionPre-existing condition of hypertension augments the association of BMI with Type 2 diabetes onset in both males and females. The presented results provide health professionals directives on the extent of weight-loss required to delay onset of Type 2 diabetes in hypertensive versus non-hypertensive patients.
Highlights
Associations between obesity and incident Type 2 diabetes mellitus (T2DM) have been extensively studied [1,2,3,4,5,6,7,8,9]
The above-cited studies have not considered hypertension as a confounder, despite the observations that hypertension is a common comorbid condition with T2DM [11], that presence of hypertension acts as a significant predictor in prognostic and diagnostic models for onset of T2DM [15,16,17,18], and that people with even pre-hypertension show a higher risk of developing T2DM than those with normal blood pressure [19]
Ethnic differences are seen in the crude prevalence (Kuwaiti natives at 28%; Asian expatriates at 37%; Arab expatriates at 34%)
Summary
Associations between obesity and incident Type 2 diabetes mellitus (T2DM) have been extensively studied [1,2,3,4,5,6,7,8,9]. Inverse linear relationships have been observed between body mass index (BMI) and age at onset of T2DM [10,11,12]. It has been shown with European population that T2DM can be diagnosed at lower BMI in men than in women [13]. Blood pressure levels are themselves correlated with BMI [20], suggesting the possibility that significant interactions may exist between BMI and hypertension in determining the risk of incident T2DM. To the knowledge of the authors, the interaction between hypertension and BMI has not been considered in studies on risk of T2DM due to obesity. We aim to quantify the interactions between hypertension and BMI on T2DM onset and attempt to quantify those interactions so as to appropriately tailor diabetes screening and prevention measures
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