Abstract 4047: Are Fat but Fit Diabetics at Risk?
Background: Obesity is associated with the development and progression of diabetes, and fitness is a well-established independent predictor of mortality. However, few studies have examined the relation of fitness to mortality in patients with diabetes, adjusted for body mass index (BMI). Therefore, we evaluated a diabetic population of male veterans referred for exercise testing to assess the relative importance of fitness and BMI as predictors of mortality.
Methods: After excluding 3 cachectic patients (BMI, <18.5 kg/m2), the study population comprised 955 consecutive patients (mean age 61 ± 10 years) referred for exercise testing. Patients were classified both according to BMI category (18.5–24.9, 25.0–29.9, and ≥30 kg/m2) and by fitness level (<5.0, 5.0–7.9, and ≥8.0 METs). The association between fitness, BMI, other clinical variables, and all-cause mortality was assessed by Cox proportional hazards.
Results: During a mean follow-up of 4.7 ± 4.2 years, a total of 219 (23%) patients died. In a multivariate analysis including clinical, risk factor and exercise test data, fitness was protective (hazard ratio = 0.88 per MET; Figure⇓), but BMI was not significantly associated with mortality. After adjustment for age, cardiovascular disease (CVD) and CVD risk factors, obese diabetics with high fitness (n = 05) were no more likely to die than lean diabetics with high fitness (n = 68).
Conclusions: We observed a strong inverse association between fitness and mortality in this cohort of men with documented diabetes, and this relationship was independent of BMI. This provides further support for the protective role of exercise training in diabetics.