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Complex interaction of fasting glucose, body mass index, age and sex on all-cause mortality: a cohort study in 15 million Korean adults – published online 19/05/2020

Mi-Hyang Jung, Sang-Wook Yi, Sang Joon An, Beverley Balkau, Jee-Jeon Yi, Hyeongsu Kim

Lean diabetes (diabetes in people with a low BMI [<25 kg/m2]) is emerging as a pathological condition that is associated with a higher mortality risk than excessive weight or grade I obese diabetes. However, it is not clear whether low BMI and hyperglycaemia have a joint effect on mortality and whether combined associations of fasting glucose levels and BMI with mortality differ by age and sex. In this issue, Jung et al (https://doi.org/10.1007/s00125-020-05160-1) use a Korean cohort study to report that: (1) the adverse effects of hyperglycaemia on mortality risk are more marked in leaner than more overweight individuals, particularly in young men and middle-aged women; and (2) the interpretation of mortality risk associated with fasting blood glucose–BMI subgroups is not straightforward because of complex interactions between fasting glucose, BMI, age and sex. For example, people with a fasting glucose level of 6.1–6.9 mmol/l and a lower normal weight (BMI 20–22.4 kg/m2) had similar or higher mortality risk than people with a fasting glucose level of 7.0–9.9 mmol/l and BMI ≥22.5 kg/m2, while obese people with diabetes had higher mortality risk than overweight people with diabetes. The authors state that this study calls for sophisticated management of patients according to the detailed metabolic profiles of each individual, including fasting glucose and BMI, as well as sex and age, to achieve better health outcomes.

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