Diabetes, not obesity, increases risk of developing critical illness and early death

Diabetes puts people at risk of developing critical illness and dying early, but obesity without diabetes does not. A study published today in the open access journal Critical Care reveals that individuals suffering from diabetes are three times more at risk of developing critical illness and dying young than individuals who do not have diabetes. Obese individuals who do not have diabetes, by contrast, have the same risk of dying or of falling critically ill as non-obese patients who do not have diabetes. These results are surprising, as obesity is linked to diabetes. The authors of the study conclude that the relationship between obesity, diabetes and critical illness is complex and that obesity, per se, does not predict poor outcomes.

Katarina Slynkova and colleagues from the University of Kentucky Chandler Hospital collaborated with colleagues from Emory University School of Medicine to analyse data from 15,408 subjects aged 44 to 66, coming from four different US communities, who had originally been studied between 1986 and 1989. The authors analysed the subjects' body mass index (BMI), presence of diabetes (either type 1 or type 2) and the subjects' history of critical illness (acute organ failure) and mortality within 3 years.

Slynkova et al.'s results show that, in the absence of diabetes, obese individuals do not have an increased risk of suffering from acute organ failure, and of dying from acute organ failure, than non-obese individuals. By contrast, patients with diabetes are three times more likely to become critically ill with acute organ failure and they are three times more likely to die from acute organ failure, or from any cause, than patients who do not have diabetes, regardless of their BMI. Slynkova et al. conclude that diabetes is a strong independent predictor of acute organ failure and subsequent death, or death from any cause.

Source

Journal abstract follows:

The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort

By: Katarina Slynkova , David M Mannino , Greg S Martin , Richard S Morehead and Dennis E Doherty

Introduction

Several studies have shown a correlation between body mass index (BMI) and both the development of critical illness and adverse outcomes in critically ill patients. The goal of our study was to examine this relationship prospectively with particular attention to the influence of concomitant diabetes mellitus (DM).

Methods

We analyzed data from 15,408 participants in the Atherosclerosis Risk in Communities (ARIC) study for this analysis. BMI and the presence of DM were defined at baseline. We defined acute organ failure as those subjects who met a standard definition with diagnostic codes abstracted from hospitalization records. Outcomes assessed included the following: risk of the development of acute organ failure within three years of the baseline examination; in-hospital death while ill with acute organ failure; and death at three years among all subjects and among those with acute organ failure.

Results

At baseline, participants with a BMI of at least 30 were more likely than those in lower BMI categories to have DM (22.4% versus 7.9%, p < 0.01). Overall, BMI was not a significant predictor of developing acute organ failure. The risk for developing acute organ failure was increased among subjects with DM in comparison with those without DM (2.4% versus 0.7%, p < 0.01). Among subjects with organ failure, both in-hospital mortality (46.5% versus 12.2%, p < 0.01) and 3-year mortality (51.2% versus 21.1%, p < 0.01) was higher in subjects with DM.

Conclusion

Our findings suggest that obesity by itself is not a significant predictor of either acute organ failure or death during or after acute organ failure in this cohort. However, the presence of DM, which is related to obesity, is a strong predictor of both acute organ failure and death after acute organ failure.

Source



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