Body mass index and the risk of total and cardiovascular mortality among patients with type 2 diabetes: a large prospective study in Ukraine

Background: Several prospective studies have evaluated the association between body mass index (BMI) and cardiovascular mortality among patients with type 2 diabetes; however, the results are controversial. Objective: To investigate the association of different BMI distributions with total and cardiovascular mortality among diabetic patients. Methods: A total of 30 534 Ukrainian men and 58 909 women with type 2 diabetes from the nationwide population-based diabetes register were included in this study. Results: During a mean follow-up of 2.7 years, 7804 deaths were recorded, of which 3320 were due to cardiovascular disease. After adjustment for age, smoking and alcohol drinking, the hazard ratios across the five BMI categories (< 23, 23-24.9, 25-29.9 (reference group), 30-34.9 and >= 35 kg/m(2)) among diabetic men were 1.57 (95% CI 1.42 to 1.74), 1.16 (1.05 to 1.28), 1.0, 1.01 (0.91 to 1.12) and 1.24 (1.02 to 1.50) for total mortality, and 1.67 (95% CI 1.42 to 1.95), 1.30 (1.12 to 1.51), 1.0, 1.13 (0.96 to 1.34) and 1.54 (1.16 to 2.05) for cardiovascular mortality, respectively. The respective hazard ratios among diabetic women were 1.34 (95% CI 1.22 to 1.47), 1.00 (0.91 to 1.10), 1.0, 1.04 (0.97 to 1.12) and 1.27 (1.14 to 1.41) for total mortality, and 1.36 (95% CI 1.18 to 1.57), 1.06 (0.92 to 1.21), 1.0, 1.12 (1.01 to 1.25) and 1.35 (1.15 to 1.59) for cardiovascular mortality. Additional adjustment for systolic blood pressure, total cholesterol, history of cardiovascular disease, diabetes treatments and duration of diabetes affected the results only slightly. Conclusions: This study indicated a U-shaped association between BMI and total and cardiovascular mortality among diabetic men and women.