Obesity-Associated Microvascular and Macrovascular Complications Among Patients With Diabetes

Obesity likely affects the pathophysiology of macrovascular and microvascular complications differently among patients with type 1 diabetes (T1D) or type 2 diabetes (T2D), according to the results of a study published in Primary Care Diabetes.

Data from this study were sourced from the National Program for Prevention and Control of Diabetes (NPPCD) and collected between 2016 and 2021 in Iran. Patients (N=111,830) with diabetes were stratified by diabetes type (T1D=10,641, T2D=101,189) and evaluated for risk of developing macrovascular and microvascular complications on the basis of obesity status (body mass index [BMI]≥30 kg/m²).

Among the T1D cohort, 7454 were not obese and 3187 were obese. The mean ages of the T1D nonobese and obese cohorts were 51.59 and 62.44 years (P <.001), 45.5% and 38.2% were men (P <.001), and 31.7% and 45.0% had uncontrolled diabetes (P <.001), respectively. Among the T2D cohort, 49,316 were not obese and 51,873 were obese. The mean ages of the T2D nonobese and obese cohorts were 62.48 and 62.43 years (P =.879), 33.4% and 27.5% were men (P <.001), and 38.2% and 48.6% had uncontrolled diabetes (P <.001), respectively.

Among both diabetes cohorts, the prevalence of cardiovascular disease (CVD), diabetic foot, nephropathy, neuropathy, and retinopathy was higher among the obese cohorts (all P <.001).

In multiple logistic regression analysis, among the T1D group, obesity was associated with increased risk for retinopathy (odds ratio [OR], 1.92; P <.001), nephropathy (OR, 1.80; P =.001), CVD (OR, 1.75; P =.001), and neuropathy (OR, 1.56; P =.004).

For the T2D cohort, obesity was associated with increased risk for neuropathy (OR, 1.98; P <.001), CVD (OR, 1.63; P <.001), and nephropathy (OR, 1.21; P <.001).

This study may have been limited by relying solely on BMI rather than using other measures of obesity, such as adiposity.

The study authors concluded that obesity is a modifiable risk factor for microvascular and macrovascular complications among patients with T1D and T2D but that the pathophysiology of these risks likely differs. Obesity was most strongly related with retinopathy among patients with T1D and with neuropathy among those with T2D.

Reference

Moosaie F, Ghaemi F, Mechanick J, et al. Obesity and diabetic complications: a study from the nationwide diabetes report of the National Program for Prevention and Control of Diabetes (NPPCD-2021)–implications for action on multiple scales. Prim Care Diabetes. Published online April 5, 2022. doi:10.1016/j.pcd.2022.03.009