Progression to Insulin Therapy in Patients With Type 2 Diabetes According to Cardiorespiratory Fitness, Body Mass Index, and Statin Therapy

Authors

Peter Kokkinos, Veterans Affairs Medical Center, Washington, DC; Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ; George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: peter.kokkinos@va.gov.
Eric Nylen, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
Charles Faselis, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
Andreas Pittaras, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
Immanuel Babu Samuel, Veterans Affairs Medical Center, Washington, DC; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Carl Lavie, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.
Michael Doumas, Veterans Affairs Medical Center, Washington, DC; Aristotle University of Thessaloniki, Thessaloniki, Greece.
Michael S. Heimall, Veterans Affairs Medical Center, Washington, DC.
Rayelynn Murphy, Veterans Affairs Medical Center, Washington, DC.
Jonathan Myers, Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Cardiology, Stanford University, Stanford, CA.

Document Type

Journal Article

Publication Date

6-29-2023

Journal

Mayo Clinic proceedings

DOI

10.1016/j.mayocp.2023.05.005

Abstract

OBJECTIVE: To evaluate the association between statin therapy, cardiorespiratory fitness (CRF), body mass index (BMI), and progression to insulin therapy in type 2 diabetes mellitus (T2DM). METHODS: Participants were patients with T2DM (mean age, 62.7±8.4 years; men, 178,992; women, 8360) not treated with insulin, with no evidence of uncontrolled cardiovascular disease, who completed an exercise treadmill test between October 1, 1999, and September 3, 2020. Of these, 158,578 were treated with statins and 28,774 were not. We established 5 age-specific CRF categories according to peak metabolic equivalents of task achieved during an exercise treadmill test. RESULTS: During a median follow-up period of 9.0 years, 51,182 patients progressed to insulin therapy with an average annual incidence rate of 28.4 events/1000 person-years. The adjusted progression rate was 27% higher in statin-treated patients (hazard ratio [HR], 1.27; 95% CI, 1.24 to 1.31), related directly to BMI and inversely related to CRF. A progressively higher rate was noted in statin-treated vs non-statin-treated patients within all BMI categories, ranging from 23% for normal weight to 90% for those with BMI of 35 kg/m and higher. The statin-CRF interaction revealed 43% higher rate in the least-fit statin-treated patients (HR, 1.43; 95% CI, 1.35 to 1.51) and a progressive decline with increased CRF to 30% lower risk in highly fit statin-treated patients (HR, 0.70; 95% CI, 0.66 to 0.75). CONCLUSION: In patients with T2DM, the statin-related progression to insulin therapy was associated with relatively low CRF and high BMI levels. The progression rate was mitigated by increased CRF regardless of BMI. Clinicians should foster regular exercise for patients with T2DM to enhance CRF and to lessen the rate of progression to insulin therapy.

APA Citation

Kokkinos, Peter; Nylen, Eric; Faselis, Charles; Pittaras, Andreas; Samuel, Immanuel Babu; Lavie, Carl; Doumas, Michael; Heimall, Michael S.; Murphy, Rayelynn; and Myers, Jonathan, "Progression to Insulin Therapy in Patients With Type 2 Diabetes According to Cardiorespiratory Fitness, Body Mass Index, and Statin Therapy" (2023). GW Authored Works. Paper 2675.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2675

Department

Clinical Research and Leadership