Strengths and limitations
type 2 diabetes
CVD, EVENTS, TYPE 2 DIABETES, ADIPOSITY
This study had several strengths. The REWIND placebo group was a large cohort of patients with type 2 diabetes and CV risk factors or established CVD. The follow-up period was long (median 5.4 years). The REWIND study protocol did not prescribe interventions on body weight or weight change advice. The REWIND trial data provided detailed information such as general and central adiposity in addition to multiple risk factors which are not typically available in other settings.This study also had limitations. This was a post hoc analysis that was not prespecified. Participants in the REWIND trial had a history of CVD or CV risk factors so results may not be generalizable to patients with no history or risk factors. Likewise, REWIND participants had type 2 diabetes which limits generalisability to other populations. The full spectrum of BMI was unlikely to be represented. Despite multivariable adjustments, some baseline differences may be unaccounted for which limits conclusions. For outcomes other than MACE, the power is low since there were much fewer events. No causal inference can be concluded from the observed associations.