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. 2017 Aug 21;12(8):e0183235.
doi: 10.1371/journal.pone.0183235. eCollection 2017.

Lean diabetes in middle-aged adults: A joint analysis of the German DIVE and DPV registries

Bettina Hartmann  1 , Stefanie Lanzinger  2   3 , Peter Bramlage  4 , Felix Groß  5 , Thomas Danne  6 , Siegfried Wagner  7 , Dietmar Krakow  8 , Artur Zimmermann  9 , Christian Malcharzik  10 , Reinhard W Holl  2   3
Affiliations

Lean diabetes in middle-aged adults: A joint analysis of the German DIVE and DPV registries

Bettina Hartmann et al. PLoS One. .

Abstract

Aims: To assess differences in demographics, treatment and outcome of lean (LD) compared to overweight and obese people with diabetes clinically classified as type 2 diabetes mellitus (T2DM).

Materials and methods: We combined data from the German DIVE (Diabetes Versorgungs-Evaluation) and DPV (Diabetes-Patienten-Verlaufsdokumentation) databases to produce a large cohort of people with T2DM. The characteristics of people with Body Mass Index (BMI) <25 kg/m2, ≥25-30 kg/m2 and ≥30 kg/m2 aged 30 to 50 years were compared, including demographics, cardiovascular (CV) risk factors, comorbidities and outcomes.

Results: A total of 37,870 people were included in the analysis, 3,191 of these (8.4%) had a BMI < 25 kg/m2. LD reported more nicotine (41.6% of 2,070 vs. 38.1% of 6,070 and 33.4% of 16,823; P<0.001)and alcohol consumption (12.0% of 1,282, 10.3% of 3,594 and 6.6% of 9,418; P<0.001)compared to overweight and obese people. More LD were treated with insulin in comparison to the other subgroups (short acting insulin 33.1% of 3,191 vs. 28.4% of 9,234 and 28.0% of 25,445; P <0.001; long acting insulin 31.3% of 3,191 vs. 28.9% of 9,234 and 29.3% of 25,445; P = 0.043). Regression models adjusted for age, gender and diabetes duration showed a 2.50 times higher odds ratio (OR) for hypoglycemia and a 2.52 higher OR for mortality in LD compared to the BMI subgroup ≥30 kg/m2.

Conclusions: LD is associated with an increased risk of hypoglycaemia and death. Patients are characterized by male gender, lifestyle habits as smoking and alcohol consumption while cardiovascular comorbidities are less important. In comparison to patients of the other weight groups they are treated with insulin more often and considerably less with metformin.

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Conflict of interest statement

Competing Interests: The DIVE registry was supported by Sanofi Aventis Deutschland GmbH, www.sanofi.de. There are no patents, products in development or marketed products to declare. PB and TD report to have received consultancy honoraria from Sanofi Aventis. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. It does not interfere with the full and objective presentation and publication of our study. The other authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient flow.
DM: diabetes mellitus; Ab: beta-cell autoantibodies; wasting disorders: malignancies, tuberculosis, chronic pancreatitis, alcoholism; BMI: body mass index.
See this image and copyright information in PMC

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