The results from a large-scale observational study carried out at German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) and the German Center for Diabetes Research (Deutsches Zentrum fuer Diabetesforschung, DZD), suggest that obesity and weight gain can lead to vascular disorders, the leading cause of disease and death for people with type 2 diabetes. The findings were reported in the paper, ‘BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study’, published in Diabetologia.
The researchers found that there was a positive linear association between pre-diagnosis BMI and risk of microvascular complications, and weight loss after diagnosis was associated with a decreased risk. However, the association between BMI and macrovascular disease was less clear.
"Most studies, however, start with people who already have diabetes, in whom weight can also be a consequence of drug therapy. We studied body mass index (BMI) before diabetes diagnosis and thus unaffected by treatment", explained first author Elli Polemiti, a doctoral student in the Department of Molecular Epidemiology headed by Professor Matthias Schulze at DIfE.
The team led by Schulze investigated whether the BMI prior to a type 2 diabetes diagnosis and a BMI change after diagnosis are associated with the occurrence of micro- and macrovascular complications. For this purpose, over a period of ten years, the research team observed about 1,000 participants of the EPIC Potsdam study with newly diagnosed type 2 diabetes who were free of other chronic diseases.
The researchers were unable to establish a clear relationship between the BMI and the occurrence of macrovascular complications. However, the situation was different with microvascular complications:
The results suggest that obesity can disrupt the function of the smallest blood vessels, arterioles and capillaries. Each five-point higher BMI at the time of diabetes diagnosis was associated with a 21 percent higher risk of microvascular complications.
"This continuously increasing risk is independent of the initial value. That is, a patient with a BMI of 35 compared to 30 has a 21 percent higher risk. Likewise, someone who has a BMI of 28 compared to 23," added Polemiti.
The research team also studied the effects of weight changes after a diabetes diagnosis. Doctors routinely recommend that overweight and obese people with type 2 diabetes lose at least five percent of their body weight to improve their metabolic condition. For a person weighing 80 kilograms, this means a loss of four kilograms. Weight loss can lead to improved blood pressure, blood lipid and blood glucose levels.
"Our data reinforce the recommendations for weight management: the greater the weight loss after diagnosis, the lower the risk for microvascular complications. However, if the subjects gained weight instead, the risk also increased," said Professor Matthias Schulze, summarizing the results.
In their observational study Schulze and his team provide a nuanced look at how overweight can promote late complications of type 2 diabetes.
"While we did not observe a clear association between overweight and macrovascular complications, our data for microvascular complications are quite clear. Our results thus underline the importance of weight loss in preventing severe diabetes-associated complications," said Polemiti.
“Our study underpins the importance of weight management in preventing major diabetes-associated complications and the need for well-designed studies for macrovascular complications,” the authors concluded.
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