Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients

Zhiting Wang; Piia Lavikainen; Katja Wikström; Tiina Laatikainen

doi:10.2147/CLEP.S450455

Trajectories of Body Mass Index and Risk for Diabetes Complications and All-Cause Mortality in Finnish Type 2 Diabetes Patients

Clin Epidemiol. 2024 Mar 29:16:203-212. doi: 10.2147/CLEP.S450455. eCollection 2024.

Authors

Zhiting Wang¹, Piia Lavikainen², Katja Wikström^{1

3}, Tiina Laatikainen^{1

3

4}

Affiliations

¹ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
² School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
³ Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
⁴ Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland.

Abstract

Objective: We aimed to assess how longitudinal body mass index (BMI) trajectories are associated with diabetes complications and all-cause mortality in Finnish patients with type 2 diabetes (T2D).

Methods: In this cohort study, electronic health records from public primary and specialized healthcare services in all 13 municipalities of North Karelia, Finland, were utilized. This study included a total of 889 adults with newly diagnosed T2D in 2011 or 2012 (mean age at baseline 62.0 years). Individual BMI trajectories from the T2D diagnosis until 2014 were estimated and grouped by growth mixture modeling (GMM). Hazard ratios (HRs) with 95% confidence intervals (CIs) for microvascular complications, macrovascular complications, any diabetes complications, and all-cause mortality from 2015 to 2022 across BMI trajectory groups were estimated using Cox regression models.

Results: Three distinct BMI trajectory groups were identified using GMM and labeled as follows: "stable" (n = 774, 87.1%), "decreasing" (n = 87, 9.8%), and "increasing" (n = 28, 3.1%). During a median follow-up of 8 years, there were 119 (13.3%) patients with microvascular complications, 187 (21.0%) with macrovascular complications, 258 (29.0%) with any diabetes complications, and 180 (20.2%) deaths. Compared with the "stable" BMI, the "increasing" BMI was associated with an increased risk of microvascular complications (HR = 2.88, 95% CI: 1.32 to 6.28), macrovascular complications (HR = 2.52, 95% CI: 1.17 to 5.43), and any diabetes complications (HR = 2.21, 95% CI: 1.16 to 4.20). The "decreasing" BMI was associated with an increased risk of all-cause mortality (HR = 1.90, 95% CI: 1.14 to 3.15), compared to the "stable" BMI.

Conclusion: Our findings underscore the significance of continuous BMI monitoring and weight management in patients with T2D. Tailored treatments are crucial for efficiently preventing weight gain and reducing the risk of diabetes complications.

Keywords: all-cause mortality; body mass index trajectory; diabetes complications; type 2 diabetes.

Grants and funding

This study was funded by the Strategic Research Council at the Academy of Finland, funding decision numbers 312703 and 336325. The funder was not involved in the study design, collection, analysis, and interpretation of the data, in writing the report, or the decision to submit the manuscript for publication.