What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes mellitus (n=15453). Intervention: Central obesity vs. Non-central obesity. Primary outcome: Incident diabetes mellitus (HR 1.72, 95% CI 1.16-2.56, p=0.0074).

August 4, 2022Open Access

Association between central obesity and incident diabetes mellitus among Japanese: a retrospective cohort study using propensity score matching

Key Result

Central obesity was independently associated with a 72% increased risk of developing incident diabetes mellitus compared to non-central obesity (HR 1.72).

Study Design

Type

Cohort (n=15,453)

Multicenter

Structured PICO

Does central obesity increase the risk of incident diabetes mellitus in Japanese adults?

Population

15,453 Japanese adults free of diabetes at baseline were followed for a mean of 6.05 years to assess the association between central obesity and incident diabetes.

Exposure

Central obesity (defined as waist-to-height ratio ≥ 0.5)

Comparator

Non-central obesity (defined as waist-to-height ratio < 0.5)

Outcome

Incident diabetes mellitus (defined as HbA1c ≥ 6.5%, fasting plasma glucose ≥ 7 mmol/L, or self-reported during follow-up)hard clinical

Central obesity is independently associated with a significantly increased risk of developing incident diabetes mellitus in Japanese adults.

Main Result

Hazard Ratio: 1.72 (95% CI 1.16–2.56)

Absolute Event Rate: 4.393% vs 2.38%

p-value: p=0.0074

Limitations

Subjects were all of Japanese ancestry, limiting generalizability to other populations.
Lack of a 2-h oral glucose tolerance test might have underestimated diabetes incidence.
PSM method does not verify the balance of unmeasured confounding covariates.
Did not consider differences between type 1, type 2, and gestational diabetes.
Incident outcomes like competing risk of death were not censored.

Abstract

Previous evidence revealed that central obesity played a vital role in the development of diabetes mellitus (DM). However, because of imbalanced confounding variables, some studies have not wholly established the association between central obesity and diabetes. Propensity score matching (PSM) analysis can minimize the impact of potential confounding variables. Therefore, the aim of the present study was to explore the relationship between central obesity and diabetes in the Japanese population by using PSM analysis. This retrospective cohort study included 15,453 Japanese adults who were free of diabetes at baseline between 2004 and 2015, which provided all medical records for individuals participating in the physical exam. Central obesity at baseline was an independent variable, and incident diabetes during follow-up was an outcome variable. Using a 1:1 PSM analysis, the present retrospective cohort study included 1639 adults with and without central obesity. Additionally, we employed a doubly robust estimation method to identify the association between central obesity and diabetes. Subjects with central obesity were 92% more likely to develop DM (HR = 1.65, 95%CI 1.12, 2.41). After adjusting for covariates, subjects with central obesity had a 72% increased risk of developing DM compared with subjects with non-central obesity in the PSM cohort (HR = 1.72, 95% CI 1.16, 2.56). Central obesity individuals had a 91% higher risk of DM than non-central obesity individuals, after adjustment for propensity score (HR = 1.91, 95% CI 1.29, 2.81). In sensitivity analysis, the central obesity group had a 44% (HR = 1.44, 95% CI 1.09, 1.90) and 59% (HR = 1.59, 95% CI1.35, 1.88) higher risk of DM than the non-central obesity group in the original and weighted cohorts after adjusting for confounding variables, respectively. Central obesity was independently associated with an increased risk of developing diabetes. After adjustment for confounding covariates, central obesity participants had a 72% higher risk of development of diabetes than non-central obesity individuals in the PSM cohort.

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