Risk of type 2 diabetes according to the cumulative exposure to metabolic syndrome or obesity: A nationwide population‐based study

• Published in: Journal of diabetes investigation 2020-11, Vol.11 (6), p.1583-1593
• Main Authors: Lee, You‐Bin, Kim, Da Hye, Kim, Seon Mee, Kim, Nan Hee, Choi, Kyung Mook, Baik, Sei Hyun, Park, Yong Gyu, Han, Kyungdo, Yoo, Hye Jin
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Alcohol; Biomarkers - analysis; Blood Glucose - analysis; Body mass index; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - pathology; Disease prevention; Family medical history; Female; Follow-Up Studies; Humans; Incidence; Lipids; Longitudinal Studies; Male; Metabolic syndrome; Metabolic Syndrome - complications; Middle Aged; Obesity; Obesity - complications; Original; Population; Population studies; Population-based studies; Prognosis; Regression analysis; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Type 2 diabetes mellitus; Womens health
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.13304

Aims/Introduction We investigated the risk of incident type 2 diabetes according to the cumulative exposure to obesity or metabolic syndrome (MetS) during annual or biennial health examinations. Materials and Methods The Korean National Health Insurance Service datasets from 2002 to 2017 were used for this retrospective longitudinal study. The risk for type 2 diabetes was analyzed according to the cumulative exposure to obesity and MetS among individuals who underwent four health examinations from 2009 to 2012 or 2013 (n = 2,851,745). Results During examinations, 28.56 and 17.86% of the total participants showed fluctuations in metabolic health state and obesity, respectively. During a mean 5.01 years of follow up, 98,950 new type 2 diabetes cases developed. The risk for type 2 diabetes increased with the increase in exposure to MetS (hazard ratio [HR] 2.92, 95% confidence interval [CI] 2.86–2.99; HR 4.96, 95% CI 4.85–5.08; HR 7.46, 95% CI 7.30–7.63; HR 12.24, 95% CI 12.00–12.49 in groups with number of exposures one to four, respectively) and obesity (HR 1.60, 95% CI 1.56–1.65; HR 1.87, 95% CI 1.81–1.92; HR 2.25, 95% CI 2.19–2.31; HR 3.46, 95% CI 3.41–3.51 in groups with number of exposures one to four, respectively), showing a more detrimental effect of cumulative exposure to MetS, when compared with the exposure to obesity. Conclusions Metabolic health and obesity fluctuated within a relatively short period of 4–5 years. Although the impact was much greater for MetS than for obesity, the cumulative duration of both obesity and MetS was associated with an increased risk of type 2 diabetes in a dose‐response manner. Therefore, continuously maintaining metabolic health and normal weight is crucial to prevent incident type 2 diabetes. In this large‐scale longitudinal study including 2,851,745 Korean adults with four annual or biennial health examinations, the metabolic health and obesity status fluctuated within a relatively short period of 4–5 years. The cumulative exposure to both metabolic syndrome and obesity was associated with an increased hazard of incident type 2 diabetes in a graded dose‐response manner, although the exposure to metabolic syndrome had a much greater impact than the exposure to obesity. Continuously maintaining metabolic health and normal weight would be warranted to prevent incident type 2 diabetes.