Strategies for glycemic control in nonobese and obese type 2 diabetic patients with coronary artery disease

Abstract

Background: This study aimed to assess strategies of insulin-providing (IP) or insulin-sensitizing (IS) therapy for glycemic control in nonobese diabetic patients with coronary artery disease (CAD) with possibly higher cardiovascular risk and lower insulin secretion than obese diabetic patients with CAD. Methods: We used data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial to calculate hazard ratio (HR) with 95% confidence interval (95%CI) for outcome events in patients with type 2 diabetes and CAD using Cox proportional hazard models. The comparison between the IP and IS groups was performed using the randomized design of the BARI 2D trial separately for nonobese (n = 1021) and obese (n = 1319) patients. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, and stroke. Results: During the follow-up, 231 nonobese and 295 obese patients had one confirmed primary outcome event. In nonobese patients, the risk of primary outcome events was significantly higher in the IP group than the IS group (HR: 1.30, 95%CI: 1.00-1.68, P = 0.04), whereas that in obese patients did not differ significantly between the two groups. Moreover, in nonobese patients, the risk of primary outcome events in those without abdominal obesity was significantly higher in the IP group than that in the IS group (HR: 1.51, 95%CI: 1.05-2.19, P = 0.02). There were no significant interactions between the strategy for glycemic control and various subgroups of nonobese patients. Conclusions: In nonobese patients with type 2 diabetes and CAD, the IS treatment strategy may be more beneficial than the IP treatment strategy.

The Pathophysiology of Type 2 Diabetes Mellitus in Non-obese Individuals: An Overview of the Current Understanding

“…The major pathophysiology appears to be a rapid beta-cell failure due to higher prevalence and early initiation of insulin use. This has been supported by many studies [27,28].…”

Trajectories of fasting glucose and glycated haemoglobin in obese and non‐obese incident diabetes: Results from two large cohort studies

“…2 Our study confirmed that obese incident diabetes had a less favourable cardiometabolic profile at the time of diagnosis, including higher BP, TC and CRP levels, as well as lower HDL, compared with non-obese diabetes. However, some studies have reported that individuals without obesity were associated with a similar or even higher risk for cardiovascular diseases and mortality 3,4,[7][8][9][10]32 as those with obesity, suggesting that the association between weight status, cardiovascular diseases and mortality may be non-linear. 10,32 In addition, the reasons why non-obese individuals can achieve a similar worsening trajectory of glucose metabolism in the development process of diabetes as obese individuals are still unknown.…”

“…[4][5][6] Emerging evidence suggests that non-obese diabetes is associated with a higher risk of cardiovascular diseases than obese diabetes. [7][8][9] Moreover, several large-scale prospective cohort studies have found that non-obese diabetes is associated with an approximately two-fold higher risk of mortality than obese diabetes. 10,11 The increasing focus on precision medicine in diabetes prevention and treatment 8,12 has highlighted the need to compare disease trajectories in individuals with obese and non-obese diabetes.…”

“…For example, in some Asian countries, the proportion of non‐obese diabetes accounted for over 60% of all diabetes cases 4–6 . Emerging evidence suggests that non‐obese diabetes is associated with a higher risk of cardiovascular diseases than obese diabetes 7–9 . Moreover, several large‐scale prospective cohort studies have found that non‐obese diabetes is associated with an approximately two‐fold higher risk of mortality than obese diabetes 10,11 .…”