Obesity, Blood Pressure, and Glycemic Control in Relation to Diabetic Complication Burden in Patients with Type 2 Diabetes Mellitus

Abstract

Coexistent vascular complications, not just hyperglycemia, are the main determinants of long-term morbidity in Type 2 Diabetes Mellitus (T2DM). Previous studies have considered complications as being either present or not, but the cumulative contribution of multiple concurrent complications and the contributions of adiposity, vascular load and concurrent glycemia to the burden remains to be better described. A cross sectional, observational, secondary analysis was conducted on 128 adults with T2DM (63 without and 65 with documented complications) from a hospital based cohort in Basrah, Iraq. Complications burden was defined as the number of 5 complications documented per participant (peripheral neuropathy, kidney disease, foot ulcer, coronary artery disease, cerebrovascular disease). The main analysis was conducted using ordinal logistic regression with the sensitivity analysis performed using binary logistic regression. Each additional 10 mmHg increase in blood pressure (systolic BP) was independently associated with higher complication burden (aOR 2.47, 95% CI 1.89–3.22), and each additional 1 kg/m2 body-mass index (BMI) was associated with higher complication burden (aOR 1.43, 95% CI 1.26–1.62), but contemporary HbA1C was not (aOR 0.90, 95% CI 0.65–1.23) in the primary adjusted model. The association was strong when defined using any blood-pressure index and any definition of a binary outcome and was unaffected by the choice of glycemic index. The multi-complication burden established in this cohort was more indicative of cardiometabolic load of adiposity and vascular load rather than current glycemia. Since the design is cross-sectional, there is no prediction or causation.