Researchers here have discovered that Asians with diabetes and heart failure fare worse in the hospital if they look trim but have a belly.
This challenges the assumption that diabetes is associated with obesity.
People in this group of diabetic and heart failure patients have large waist-to-height ratios and low body mass index, said the National Heart Centre Singapore (NHCS) on Friday.
These "lean-fat" patients had the highest risk of poor hospitalisation outcomes compared with other patients with diabetes and heart failure, researchers at NHCS found.
Dr Chanchal Chandramouli, a research fellow at NHCS, said on Friday: "The lean diabetic cluster was associated with the worst quality of life and composite outcomes, with 79 per cent greater risk of hospitalisation and mortality at one year, compared with other clusters."
This group of patients was compared with four other groups of patients in Asia that had diabetes and heart failure - the elderly, the young, those who are obese and have hypertension, and those with narrowing arteries or reduced blood flow to the heart.
Professor Carolyn Lam, a senior consultant at the centre's department of cardiology, said that knowing the dismal prognosis of lean diabetic patients with heart failure and the lack of proven therapies to improve their prognosis, NHCS researchers firmly believe that preventing future cardiac disease among high-risk diabetic patients with no symptoms is extremely critical.
Meanwhile, the researchers are also working on an Asia-wide study on preventive treatment for diabetic individuals identified to have a high risk of developing heart disease.
The Asian Diabetes Outcome Prevention Trial (Adopt) study will see researchers from NHCS working with their counterparts from Malaysia, China, Taiwan, India and the United Arab Emirates, the centre said on Friday.
The Adopt team aims to recruit 2,400 volunteers for its study, with a follow-up over a duration of four years.
Diabetic individuals with a high risk of heart disease will be identified using blood biomarker-based screening for intensive preventive treatment.
Associate Professor David Sim, director of NHCS' heart failure programme, said the treatment will involve prescribing drugs typically used to treat heart disease to patients who have been identified as high-risk, but who have no pre-existing cardiovascular diseases.
WHO'S AT RISK?
Asians with diabetes and heart disease who:
• Look trim but have a belly
• Have large waist-to-height ratios
• Have low body mass index
"If Adopt proves that a simple blood test can identify individuals with diabetes who will benefit from intensive preventive therapy with commonly available medications, results can directly impact clinical practice not only in Singapore, but also in other parts of the world," said Prof Lam.
The study follows earlier findings by NHCS researchers - who compared data of Asian and Caucasian patients with heart failure between 2012 and 2016 - that three times as many Asian than Caucasian heart disease patients had diabetes.