BMI and Mortality in Patients With New-Onset Type 2 Diabetes: A Comparison With Age- and Sex-Matched Control Subjects From the General Population

OBJECTIVE Type 2 diabetes is strongly associated with obesity, but the mortality risk related to elevated body weight in people with type 2 diabetes compared with people without diabetes has not been established. RESEARCH DESIGN AND METHODS We prospectively assessed short-and long-term mortality in people with type 2 diabetes with a recorded diabetes duration <= 5 years identified from the Swedish National Diabetes Register (NDR) between 1998 and 2012 and five age-and sex-matched control subjects per study participant from the general population. RESULTS Over a median follow-up of 5.5 years, there were 17,546 deaths among 149,345 patients with type 2 diabetes (mean age 59.6 years [40% women]) and 68,429 deaths among 743,907 matched control subjects. Short-term all-cause mortality risk (<= 5 years) displayed a U-shaped relationship with BMI, with hazard ratios (HRs) ranging from 0.81 (95% CI 0.75-0.88) among patients with diabetes and BMI 30 to < 35 kg/m(2) to 1.37 (95% CI 1.11-1.71) with BMI >= 40 kg/m(2) compared with control subjects after multiple adjustments. Long-term, all weight categories showed increased mortality, with a nadir at BMI 25 to < 30 kg/m(2) and a stepwise increase up to HR 2.00 (95% CI 1.58-2.54) among patients with BMI >= 40 kg/m(2), that was more pronounced in patients < 65 years old. CONCLUSIONS Our findings suggest that the apparent paradoxical findings in other studies in this area may have been affected by reverse causality. Long-term, overweight (BMI 25 to < 30 kg/m(2)) patients with type 2 diabetes had low excess mortality risk compared with control subjects, whereas risk in those with BMI >= 40 kg/m(2) was substantially increased.