Obesity and the 5-Year Prevalence of Morbidity and Mortality in Adults with T2DM Exploring the Link
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24 Apr, 23

Introduction

 

The incidence of obesity and type-2 diabetes mellitus (T2DM) is increasing currently. Studies in past have demonstrated that both T2DM and obesity are associated with various comorbidities and premature death.

 

Aim

  • To observe the 5-year prevalence and incidence of cardiovascular, microvascular and other comorbidities and mortality in obese American adults with T2DM.

  • To compare the prevalence of death and comorbidity across obesity categories in the study population.

 

Patient Profile

  • Obese adults (Body mass index [BMI] 30 kg/m2) with T2DM (n=15970)

  • The study participants were classified as per their obesity class as: class 1 (30-<35 kg/m2), class 2 (35-<40 kg/m2) and class 3 (≥40 kg/m2)

 

Methods

 

Study Design

  • Retrospective study

 

Outcomes

  • Mortality

  • Composite cardiovascular outcome (CCO)

  • Composite microvascular outcome (CMO)

  • Other complications

 

Results

  • A total of 15970 patients were included in this study with the following stratification as per obesity class [Class 1 (n=7513), Class 2 (n=4635), Class 3 (n=3822)]

  • The average age of the study population was 62.4 years, and 51% of the study population comprised of females.

  • The 5-year mortality rate was 11%, the mortality was significantly highest in individuals with obesity class 3, vs. class 2 and 1 (Fig. 1).

  • The 5-year prevalence of CCO was 15.3%, the same was significantly highest in individuals with class 3 obesity (Fig. 1).

  • The 5-year prevalence of CMO was 60.7%, the same was significantly highest in individuals with class 3 obesity (Fig. 1).

 

Fig. 1: The 5-year outcomes as per the obesity class

All differences between class 3 and class 2/ class 1 were significant

  • Adults with obesity class 3 had a higher incidence of neuropathy vs. those with obesity class 1 and 2, and a higher incidence of nephropathy vs. obesity class 1 (Table 1).

  • Incidence of obstructive sleep apnea (OSA), and atherosclerotic vascular disease (ASCVD) increased significantly with the increasing class of obesity (Table 1).

  • The incidences of atrial fibrillation, liver cirrhosis and NASH/NAFLD were significantly higher in adults with obesity class 3 vs. obesity class 1 or 2 (Table 1)

 

Table 1: Incidence of various individual outcomes as per the obesity class 

 
 
 
 
 
 
 

Outcome

 
 
 
 

Obesity Class

 
 

Class 1 (95% CI)

 
 

Class 2 (95% CI)

 
 

Class 3 (95% CI)

 
 
 
 

Neuropathy

 
 

34.7 (33.7–35.8)

 
 

36.3 (34.9–37.7)

 
 

45.2 (43.6–46.8)

 
 
 
 

Nephropathy

 
 

29.2 (28.2–30.2)

 
 

29.7 (28.4–31.1)

 
 

32.3 (30.8–33.8)

 
 
 
 

OSA

 
 

19.4 (18.5–20.3)

 
 

31.2 (29.9–32.5)

 
 

47.2 (45.7–48.8)

 
 
 
 

ASCVD

 
 

77.1 (76.1–78.0)

 
 

81.5 (80.4–82.6)

 
 

85.5 (84.3–86.6)

 
 
 
 

Atrial Fibrillation

 
 

7.7 (7.1–8.3)

 
 

8.7 (7.9–9.5)

 
 

12.7 (11.7–13.8)

 
 
 
 

Liver Cirrhosis

 
 

20.2 (19.3–21.1)

 
 

21.9 (20.7–23.1)

 
 

28.7 (27.3–30.2)

 
 
 
 

NASH/NAFLD

 
 

17.0 (16.2–17.9)

 
 

20.5 (19.3–21.6)

 
 

23.2 (21.8–24.5)

All differences between class 3 and class 2/ class 1 were significant

 

Conclusions 

  • Amongst obese adults with T2DM, obesity class 3 was associated with significantly higher mortality and morbidity, including CCO, CMO, ASCVD and OSA. 

  • Initiating treatment to reduce obesity among these adults with T2DM may have significant health benefits.

 

Diabetes Ther. 2023;14:709–721.