Abstract
AimsTo assess differences in demographics, treatment and outcome of lean (LD) compared to overweight and obese people with diabetes clinically classified as type 2 diabetes mellitus (T2DM).Materials and methodsWe combined data from the German DIVE (Diabetes Versorgungs-Evaluation) and DPV (Diabetes-Patienten-Verlaufsdokumentation) databases to produce a large cohort of people with T2DM. The characteristics of people with Body Mass Index (BMI) <25 kg/m2, ≥25–30 kg/m2 and ≥30 kg/m2 aged 30 to 50 years were compared, including demographics, cardiovascular (CV) risk factors, comorbidities and outcomes.ResultsA total of 37,870 people were included in the analysis, 3,191 of these (8.4%) had a BMI < 25 kg/m2. LD reported more nicotine (41.6% of 2,070 vs. 38.1% of 6,070 and 33.4% of 16,823; P<0.001)and alcohol consumption (12.0% of 1,282, 10.3% of 3,594 and 6.6% of 9,418; P<0.001)compared to overweight and obese people. More LD were treated with insulin in comparison to the other subgroups (short acting insulin 33.1% of 3,191 vs. 28.4% of 9,234 and 28.0% of 25,445; P <0.001; long acting insulin 31.3% of 3,191 vs. 28.9% of 9,234 and 29.3% of 25,445; P = 0.043). Regression models adjusted for age, gender and diabetes duration showed a 2.50 times higher odds ratio (OR) for hypoglycemia and a 2.52 higher OR for mortality in LD compared to the BMI subgroup ≥30 kg/m2.ConclusionsLD is associated with an increased risk of hypoglycaemia and death. Patients are characterized by male gender, lifestyle habits as smoking and alcohol consumption while cardiovascular comorbidities are less important. In comparison to patients of the other weight groups they are treated with insulin more often and considerably less with metformin.
Highlights
The majority of patients with type 2 diabetes mellitus (T2DM) are obese or overweight
Regression models adjusted for age, gender and diabetes duration showed a 2.50 times higher odds ratio (OR) for hypoglycemia and a 2.52 higher OR for mortality in LD compared to the body mass index (BMI) subgroup !30 kg/m2
In comparison to patients of the other weight groups they are treated with insulin more often and considerably less with metformin
Summary
The majority of patients with type 2 diabetes mellitus (T2DM) are obese or overweight. Few studies have investigated the subgroup of patients with a clinical diagnosis of type 2 diabetes and a low to normal body mass index (BMI) (< 25 kg/m2). Percentages of these lean diabetic participants ranged from 7.5% to 21% [1,2,3,4,5]. Lean diabetes patients might have higher total and non- cardiovascular mortality when compared to obese diabetic patients [1, 6], whereas, most studies reported a lower cardiovascular mortality compared to participants with BMI > 25 kg/m2 [2, 3]. Participants with T1DM, latent onset autoimmune diabetes of the adult (LADA), maturity onset diabetes of the young (MODY, especially type 3), participants with secondary diabetes as a consequence of pancreatitis, participants with type 2 diabetes and wasting diseases (i.e. malignancies, tuberculosis, aquired immunodeficiency syndrome) as well as T2DM with a low to normal body weight were included in the subgroup of lean diabetes, depending on the respective inclusion criteria [7, 8]
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