Temporal trends in BMI among adults with diabetes

OBJECTIVE - Increasing obesity within the general population has been accom panied by rising rates of diabetes. The extent to which obesity has increas ed among people with diabetes is unknown, as are the potential consequences for diabetes outcomes. RESEARCH DESIGN AND METHODS - Community medical records (hospital and ambul atory) of all Rochester, Minnesota, residents aged 30 years who first met s tandardized research criteria for diabetes from 1970 to 1989 (n = 1,306) we re reviewed to obtain data on BMI and related characteristics as of the dia betes identification date (+/-3 months), Vital status as of 31 December 199 9 and date of death for those who died were obtained from medical records, State of Minnesota death tapes, and active follow-up, RESULTS - As of the identification date, data on BMI were available for 1,2 90 cases, Of the 272 who first met diabetes criteria in 1970-1974, 33% were obese (BMI greater than or equal to 30), including 5% who were extremely o bese (BMI greater than or equal to 40), These proportions increased to 49% (P < 0.001) and 9% (P = 0.012), respectively, for the 426 residents who fir st met diabetes criteria in 1985-1989. BMI increased significantly with inc reasing calendar year of diabetes identification in multivariable regressio n analysis. Analysis of survival revealed an increased hazard of mortality for BMI greater than or equal to 41, relative to BMI of 23-25 (hazard ratio 1.60, 95% Cl 1.09-2.34, P = 0.016). CONCLUSIONS - The prevalence of obesity and extreme obesity among individua ls at the time, they first met criteria for diabetes has increased over Lim e, This is disturbing in light of the finding that diabetic individuals who are extremely obese are -,it increased risk of mortality compared with the ir nonobese diabetic counterparts.