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Adiposity Without Metabolic Dysfunction May Increase Type 2 Diabetes Risk

It is well known that obesity has detrimental effects on health, but few prospective studies have been done to assess its relationship to developing problems later on such as diabetes. Furthermore, little is known on the specific prospective effect of pre-existent metabolic dysfunction as a risk factor leading to diabetes, as well.

The study was recently published in Diabetes Care and evaluated data from 6,977 participants from the prospective SMART cohort study. The goal was to determine the role of BMI and metabolic dysfunction as risk factors leading to the development of diabetes in patients with pre-existent vascular disease or at high risk.

Patients were followed for an average of six years and placed into groups based BMI: normal weight (less than 25 kg/m2), overweight (between 25 to 30 kg/m2) and obese (30 kg/m2 or greater). Metabolic dysfunction was assessed using revised NCEP criteria.
In the course of the study, 519 of the patients developed type 2 diabetes. In patients without metabolic dysfunction, adiposity was significantly associated with an increased risk for developing type 2 diabetes (HR=4.3 in obese patients). In all patient groups, metabolic dysfunction defined as three or more NCEP criteria was associated with a significant increased risk for diabetes.

Overall, adiposity alone contributes to a significantly increased risk of developing type 2 diabetes in patients. Furthermore, pre-existent metabolic dysfunction has a significant association despite BMI.

Clearly, the assessment of BMI and addressing the issue is important for all patients even before diagnosis of diabetes. Addressing metabolic dysfunction is important for all patients, even those with a normal BMI.

Practice Pearls:

  • Previous research has suggested antibiotics may alter gut flora and change sugar metabolism—a potential link to type 2 diabetes.
  • This population-based case-control study suggests a possible link to antibiotic exposure and type 2 diabetes risk.
  • Further prospective research needs to be conducted to evaluate this association.

Franssens, Bas T., Yolanda Van Der Graaf, Jaap L. Kappelle, et al. “Body Weight, Metabolic Dysfunction, and Risk of Type 2 Diabetes in Patients at High Risk for Cardiovascular Events or With Manifest Cardiovascular Disease: A Cohort Study.” Diabetes Care Dia Care (2015): Dc150684. Web. 10 Sept. 2015. .