title: Body mass index-mortality relationship in severe hypoglycemic patients with type 2 diabetes.
abstract: BACKGROUND
  Hypoglycemia is associated with a higher risk of death. This study analyzed various body mass index (BMI) categories and mortalities of severe hypoglycemic patients with type 2 diabetes mellitus (DM) in a hospital emergency department.
  
  
  METHODS
  The study included 566 adults with type 2 diabetes who were admitted to 1 medical center in Taiwan between 2008 and 2009 with a diagnosis of severe hypoglycemia. Mortality data, demographics, clinical characteristics and the Charlson's Comorbidity Index were obtained from the electronic medical records. Patients were stratified into 4 study groups as determined by the National Institute of Health (NIH) and World Health Organization classification for BMI, and the demographics were compared using the analysis of variance and χ² test. Kaplan-Meier's analysis and the Cox proportional-hazards regression model were used for mortality, and adjusted hazard ratios were adjusted for each BMI category among participants.
  
  
  RESULTS
  After controlling for other possible confounding variables, BMI <18.5 kg/m² was independently associated with low survival rates in the Cox regression analysis of the entire cohort of type 2 DM patients who encountered a hypoglycemic event. Compared to patients with normal BMI, the mortality risk was higher (adjusted hazard ratios = 4.9; 95% confidence interval [CI] = 2.4-9.9) in underweight patients. Infection-related causes of death were observed in 101 cases (69.2%) and were the leading cause of death.
  
  
  CONCLUSIONS
  An independent association was observed between BMI less than 18.5 kg/m² and mortality among type 2 DM patient with severe hypoglycemic episode. Deaths were predominantly infection related.
authors.affiliation: Department of Emergency Medicine (T-CT, C-TK, F-CC, C-JL), Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Public Health (C-HL), Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science (B-CC), National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medicine (B-CC), Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan; Division of Metabolism, Department of Internal Medicine (F-CS), Kaohsiung Chang Gung Memorial, Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Emergency Medicine (Y-CC), Chang Gung Memorial Hospital, Puzih City, Taiwan; and Department of Medicine, Chang Gung University College of Medicine (Y-CC), Taoyuan County, Taiwan.
authors.forename: Tsung-Cheng
authors.initials: TC
authors.lastname: Tsai
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
authors.forename: Chia-Te
authors.initials: CT
authors.lastname: Kung
authors.forename: Fu-Cheng
authors.initials: FC
authors.lastname: Chen
authors.forename: Feng-Chih
authors.initials: FC
authors.lastname: Shen
authors.forename: Chao-Jui
authors.initials: CJ
authors.lastname: Lee
authors.forename: Yi-Chuan
authors.initials: YC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents