Issue 146 Item 6 Excess Weight for Older People with Diabetes Predicts Better Su

Obesity is a negative prognostic factor in type 2 diabetics who are younger than 65 years, but higher body weight in older patients predicts better survival.

The effect of obesity on mortality in patients under 65 years old appears to be mediated in part by hypertension, duration of diabetes and fasting plasma glucose, according to investigators from the Division of Endocrinology and Metabolic Diseases and the Division of Medical Statistics at the University of Verona Medical School in Verona, Italy. A cohort of 3,398 patients with type 2 diabetes was followed for a period of 10 years. Survival in the different quartiles of body mass index was evaluated using two Cox models. One model controlled for sex, age, treatment and smoking. The second model controlled for the previous variables and for hypertension, duration of diabetes and fasting plasma glucose levels.

During the follow-up period there were 1,212 deaths. A significantly higher all-cause mortality was observed in patients under 65 years old who were in the highest body mass index quartile. Inclusion of hypertension, duration of diabetes and fasting plasma glucose in the Cox model resulted in a slightly lower relative risk in these patients.

In older type II diabetic patients, a moderate excess weight predicts a better survival, while obesity is a negative prognostic factor in patients younger than 65 y. In the latter patients, the effect of obesity on mortality seems to be partly mediated by hypertension, duration of diabetes, and fasting plasma glucose. International Journal of Obesity (2003) 27, 281-285.