Association of Weight Status With Mortality in Adults With Incident Diabetes

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Abstract
Type 2 diabetes in normal-weight adults is an understudied representation of the metabolically obese normal-weight phenotype1 that has become increasingly common over time.2 It is not known whether the “obesity paradox” that has been observed in chronic diseases such as heart failure, chronic kidney disease, and hypertension extends to adults who are normal weight at the time of incident diabetes.3-5 In 2 contemporary studies, the Translating Research Into Action for Diabetes (TRIAD) study6 and the PROactive trial,7 participants with diabetes who were normal weight at the baseline examination or who lost weight during the trial (PROactive) experienced higher mortality than participants who were overweight or obese. Limitations of these prevalent disease studies are that participants had diabetes of unknown duration and participants from the PROactive trial had preexisting cardiovascular disease at baseline.