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Author Notes:

Correspondence to Professor Guillermo E Umpierrez; Email:geumpie@emory.edu

A-SA and GEU designed the study and wrote the proposal and manuscript.

MF, LB, DS, FJP, PV, and JSH contributed to the analysis and interpretation, as well as reviewing the manuscript.

JW was in charge of data collection and LZ from the School of Public health conducted the statistical analysis.

All listed authors were involved in critically revising the manuscript and approved the final version of the paper to be published.

The abstract of this study was previously presented at Endo Society, March 2015.

Competing interests: None declared.


Research Funding:

This study was supported by the Jacobs Family Research Funds (GEU).

GEU is supported in part by research grants from the American Diabetes Association (1-14-LLY-36), and Public Health service (PHS) grant from the Clinical Translational Science Award Program (M01 RR-00 039), National Institutes of Health, National Center for Research Resources.


  • Hyperglycemia
  • Obesity
  • Type 2 Diabetes

Impact of obesity on hospital complications and mortality in hospitalized patients with hyperglycemia and diabetes.


Journal Title:

BMJ Open Diabetes Research and Care


Volume 4, Number 1


, Pages e000200-e000200

Type of Work:

Article | Final Publisher PDF


OBJECTIVE: Obesity is associated with increased risk of diabetes, hypertension and cardiovascular mortality. Several studies have reported increased length of hospital stay and complications; however, there are also reports of obesity having a protective effect on health, a phenomenon coined the 'obesity paradox'. We aimed to investigate the impact of overweight and obesity on complications and mortality in hospitalized patients with hyperglycemia and diabetes. RESEARCH DESIGN AND METHODS: This retrospective analysis was conducted on 29 623 patients admitted to two academic hospitals in Atlanta, Georgia, between January 2012 and December 2013. Patients were subdivided by body mass index into underweight (body mass index <18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)) and obese (>30 kg/m(2)). Hyperglycemia was defined as a blood glucose >10 mmol/L during hospitalization. Hospital complications included a composite of pneumonia, acute myocardial infarction, respiratory failure, acute kidney injury, bacteremia and death. RESULTS: A total of 4.2% were underweight, 29.6% had normal weight, 30.2% were overweight, and 36% were obese. 27.2% of patients had diabetes and 72.8% did not have diabetes (of which 75% had hyperglycemia and 25% had normoglycemia during hospitalization). A J-shaped curve with higher rates of complications was observed in underweight patients in all glycemic groups; however, there was no significant difference in the rate of complications among normal weight, overweight, or obese patients, with and without diabetes or hyperglycemia. CONCLUSIONS: Underweight is an independent predictor for hospital complications. In contrast, increasing body mass index was not associated with higher morbidity or mortality, regardless of glycemic status. There was no evidence of an obesity paradox among inpatients with diabetes and hyperglycemia.

Copyright information:

© 2016, British Medical Journal Publishing Group

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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