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Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort

  • M.A. Salinero-Fort
    Correspondence
    Corresponding author at: Subdirección General de Investigación Sanitaria, Consejería de Sanidad, C/ Aduana, 29, 28013 Madrid, Spain.
    Affiliations
    Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain

    MADIABETES Research Group, Spain

    Aging and Fragility in the Elderly Group—IdiPAZ, Madrid, Spain

    Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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  • F.J. San Andrés-Rebollo
    Affiliations
    MADIABETES Research Group, Spain

    Centro de Salud Las Calesas, Madrid, Spain
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  • P. Gómez-Campelo
    Affiliations
    MADIABETES Research Group, Spain

    Aging and Fragility in the Elderly Group—IdiPAZ, Madrid, Spain

    Plataforma de Apoyo al Investigador Novel (PAIN Platform), Hospital La Paz Institute for Health Research (IdiPAZ), Servicio Madrileño de Salud, Madrid, Spain
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  • C. de Burgos-Lunar
    Affiliations
    MADIABETES Research Group, Spain

    Aging and Fragility in the Elderly Group—IdiPAZ, Madrid, Spain

    Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain

    Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain
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  • J. Cárdenas-Valladolid
    Affiliations
    MADIABETES Research Group, Spain

    Aging and Fragility in the Elderly Group—IdiPAZ, Madrid, Spain

    Dirección Técnica Sistemas de Información, Gerencia Asistencial de Atención Primaria, Madrid, Spain
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  • J.C. Abánades-Herranz
    Affiliations
    MADIABETES Research Group, Spain

    Aging and Fragility in the Elderly Group—IdiPAZ, Madrid, Spain

    Centro de Salud Monóvar, Servicio Madrileño de Salud, Madrid, Spain
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  • A. Otero-Puime
    Affiliations
    Departamento de Medicina y Salud Pública, Facultad de Medicina, Universidad Autónoma, Madrid, Spain
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  • R. Jiménez-García
    Affiliations
    MADIABETES Research Group, Spain

    Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (Campus de Alcorcón), Madrid, Spain
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  • A. López-de-Andrés
    Affiliations
    MADIABETES Research Group, Spain

    Departamento de Medicina Preventiva y Salud Pública, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (Campus de Alcorcón), Madrid, Spain
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  • J.M. de Miguel-Yanes
    Affiliations
    MADIABETES Research Group, Spain

    Hospital Gregorio Marañón, Madrid, Spain

    Facultad de Medicina, Universidad Complutense, Madrid, Spain
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  • on behalf of theMADIABETES Research Group
    Author Footnotes
    1 The MADIABETES Research Group (https://www.madiabetes.com) is a multidisciplinary group composed by general practitioners and nurses from 55 Health Centers in Madrid (Spain) who attend patients with type 2 diabetes mellitus, and researchers of Public Institutions with a high interest to know the factors associated with the optimal evolution of the patients with this chronic disease.
  • Author Footnotes
    1 The MADIABETES Research Group (https://www.madiabetes.com) is a multidisciplinary group composed by general practitioners and nurses from 55 Health Centers in Madrid (Spain) who attend patients with type 2 diabetes mellitus, and researchers of Public Institutions with a high interest to know the factors associated with the optimal evolution of the patients with this chronic disease.

      Highlights

      • In a Spanish cohort of T2DM outpatients, mortality rate is 26.38/per 1000 patient-years.
      • In males, the BMI value showing the highest all-cause mortality is <23 kg/m2.
      • Higher BMIs are not associated with higher mortality rates in either males or females.

      Abstract

      Purpose

      To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences.

      Methods

      3443 T2DM outpatients were studied. At baseline and annually, patients were subjected to anamnesis, a physical examination, and biochemical tests. Data about demographic and clinical characteristics was also recorded, as was the treatment each patient had been prescribed. Mortality records were obtained from the Spanish National Institute of Statistics. Survival curves for BMI categories (Gehan-Wilcoxon test) and a multivariate Cox proportional hazard analysis were performed to identify adjusted Hazard Ratios (HRs) of mortality.

      Results

      Mortality rate was 26.38 cases per 1000 patient-years (95% CI, 23.92–29.01), with higher rates in men (28.43 per 1000 patient-years; 95% CI, 24.87–32.36) than in women (24.31 per 1000 patient-years; 95% CI, 21.02–27.98) (p = 0.079). Mortality rates according to BMI categories were: 56.7 (95% CI, 40.8–76.6), 28.4 (95% CI, 22.9–34.9), 24.8 (95% CI, 21.5–28.5), 21 (95% CI, 16.3–26.6) and 23.7 (95% CI, 14.3–37) per 1000 person-years for participants with a BMI of <23, 23–26.8, 26.9–33.1, 33.2–39.4, and >39.4 kg/m2, respectively. The BMI values associated with the highest all-cause mortality were <23 kg/m2, but only in males [HR: 2.78 (95% CI, 1.72–4.49; p < 0.001)], since in females this association was not significant [HR: 1.14 (95% CI, 0.64–2.04; p = 0.666)] (reference category for BMI: 23.0–26.8 kg/m2). Higher BMIs were not associated with higher mortality rates.

      Conclusions

      In an outpatient T2DM Mediterranean population sample, low BMI predicted all-cause mortality only in males.

      Keywords

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