Friday , October 20 2017
Home / Resources / Articles / The “Obesity Paradox” in Type 2 Diabetes

The “Obesity Paradox” in Type 2 Diabetes

Increased mortality from cardiovascular outcomes found in overweight patients but…. 

In general, weight loss is recommended for most patients with type 2 diabetes. However, literature also suggests that weight loss may be associated with decreased survival in patients with cardiovascular (CV) comorbidities.

A recent study published in the International Journal of Cardiology set out to determine the relationship between body weight change and mortality and non-fatal cardiovascular outcomes in patients with both type 2 diabetes and CV comorbidities. Non-fatal cardiovascular outcomes included were hospitalization, myocardial infarction (MI), and stroke. Researchers also investigated the effect of mortality due to weight changes induced by pioglitazone.

The study population included 5,202 patients from the PROactive trial population assessed in a post hoc analysis for changes in body weight. Researchers randomized patients to either pioglitazone or placebo group and had a mean follow up period of 34.5 months.

Researchers found that weight loss was significantly associated with increased overall mortality, with a hazard ratio (HR) per 1% body weight of 1.13 (P<0.0001). This increased overall mortality included the outcome measures for mortality from cardiovascular outcomes including hospitalization, myocardial infarction (MI), and stroke. Pioglitazone-induced weight-gain was indicative of a more positive prognosis, however (HR per 1% weight gain: 0.96, P=0.037).

Authors concluded that overweight and obese patients with type 2 diabetes and concurrent CV comorbidities had lower mortality rates as compared to patients with normal weight. There appears to be an "obesity paradox," in which weight loss, but not weight gain may be linked to increased mortality and morbidity in this patient population.

Practice Pearls:
  • Obese patients with type 2 diabetes and concurrent CV comorbidities had lower mortality rates as compared to patients with normal weight.
  • Pioglitazone-induced weight-gain may be indicative of a more positive prognosis.
  • There appears to be an "obesity paradox", in which weight loss, but not weight gain may be linked to increased mortality and morbidity in this patient population.

Diabetes/Metabolism Research & Reviews 2014. [Doehner, W. et al. Inverse relation of body weight and weight change with mortality and morbidity in patients with type 2 diabetes and cardiovascular co-morbidity: An analysis of the PROactive study population. International Journal of Cardiology. 2012;162:20-26.]