里程碑:牛津学者:糖尿病患者早期控糖决定未来20年的死亡风险!

2021-07-14 MedSci原创 MedSci原创

T2DM患者血糖控制“遗留效应”提示了早期控糖的重要性:早期发现糖尿病并从诊断时开始强化血糖控制,对于最大限度地减少血糖并发症的长期风险至关重要。

近几十年来,生活环境的巨大变化带来了肥胖率愈加严重,随之而出现的糖尿病患病率也快速增长。这一个庞大的基数,意味着将会有相当比例的年轻人即将或者已经步入糖尿病阶段。

有充分的证据显示,年轻时期诊断为2型糖尿病(T2DM)的人群,预期寿命将会缩短,全因死亡率更高。但目前研究并没有将糖尿病诊断年龄进行分层来比较死亡率风险,并且没有考虑到糖尿病病程等影响因素。此外,较少研究去探讨糖尿病诊断年龄对血管及非心血管疾病死亡率的影响。

在糖尿病治疗的过程中,存在一种“遗留效应”,也称为“代谢记忆”,是指短期的严格血糖控制能使患者长期获益,相比未经过严格控制的患者,严格控制过的患者的并发症风险和死亡率在多年后也更低,即使他们近年的血糖水平是相似的。

2008年,发表在NEJM上的英国前瞻性糖尿病研究(UKPDS)曾报道称,早期强化降糖可使糖尿病相关终点的风险降低12-32%,并且能带来长达10年的持久效益。为此提出,“遗留效应”是糖尿病及其并发症之间的桥梁,也是血糖管理的挑战。

然而,早期血糖控制的“遗留效应”对T2DM患者全因死亡率(ACM)和心肌梗死(MI)的影响并不清楚。近日,来自英国牛津大学和哥德堡大学的专家合作团队进一步对UKPDS的后续结果进行了分析,结果发表在《糖尿病护理》Diabetes Care杂志上。

从3802名UKPDS参与者的T2DM诊断开始,研究人员评估了20年的ACM和MI危险函数。根据HbA1c值对下游ACM和MI风险的影响进行加权分析,以判断历史HbA1c水平与后续20年ACM和MI的关联程度如何随着时间推移而变化。

早期暴露时间和随访期

结果显示,在5年、10年和20年时,HbA1c高一个百分点,ACM风险分别增加8%、18%和36%(HR=1.08,95% CI:1.07-1.09、HR=1.18,95% CI:1.15-1.21和HR=1.36, 95% CI:1.30-1.42)。同时MI风险在5、20年时分别增加13%与31%(HR=1.13,95% CI:1.11-1.15、HR=1.31,95% CI:1.25-1.36)。

确诊T2DM当时(绿线)、5年后(蓝色)和10年后(红色)HbA1c分别降幅1%在确诊后10-20年ACM和MI风险变化

从诊断开始将HbA1c降低一个百分点,10-15年后ACM风险降低18.8%(95% CI 21.1-16.0),而将这种降低推迟到诊断后10年,风险降低的效益就减少到2.7%(3.1-2.3)。在诊断时降低HbA1c,相应的MI风险降低率为19.7%(22.4-16.5),而在10年后实施,风险降低率为3倍,为6.5%(7.4-5.3%)。

由此可见,T2DM患者血糖控制“遗留效应”提示了早期控糖的重要性:早期发现糖尿病并从诊断时开始强化血糖控制,对于最大限度地减少血糖并发症的长期风险至关重要。

 

参考文献:

Historical HbA1c Values May Explain the Type 2 Diabetes Legacy Effect: UKPDS 88. Diabetes Care 2021 Jun; dc202439.https://doi.org/10.2337/dc20-2439

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    2022-05-08 xzw113
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    2021-07-14 顿大侠

    所以严格控制糖分的摄入对寿命是有好处的

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=2059333, encodeId=f173205933357, content=<a href='/topic/show?id=9fbe95e0015' target=_blank style='color:#2F92EE;'>#里程碑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95700, encryptionId=9fbe95e0015, topicName=里程碑)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2317301, createdName=xzw113, createdTime=Sun May 08 20:24:25 CST 2022, time=2022-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256111, encodeId=670412561112e, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Fri Jul 16 05:24:25 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1475103, encodeId=004b14e51037b, content=<a href='/topic/show?id=935fe6718e3' target=_blank style='color:#2F92EE;'>#糖尿病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76718, encryptionId=935fe6718e3, topicName=糖尿病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a38f7243741, createdName=xue8604, createdTime=Fri Jul 16 05:24:25 CST 2021, time=2021-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999598, encodeId=29289995989e, content=所以严格控制糖分的摄入对寿命是有好处的, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65995533818, createdName=顿大侠, createdTime=Wed Jul 14 23:26:53 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999591, encodeId=17f5999591ee, content=<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=c7ad5218670, createdName=14775a26m11暂无昵称, createdTime=Wed Jul 14 23:15:55 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043693, encodeId=bc161043693cd, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Jul 14 17:24:25 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999410, encodeId=d66d999410a9, content=严格控糖,义不容辞, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5d2f5531172, createdName=ms6000001833964428, createdTime=Wed Jul 14 15:13:21 CST 2021, time=2021-07-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=999400, encodeId=1829999400f9, content=学习了,好, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201117/a59b28b63198490ea85b1e5b3d13c2bf/1b1e0d03ca22467d8120443ebbc24c04.jpg, createdBy=35d22207591, createdName=zhangxiang, createdTime=Wed Jul 14 14:53:43 CST 2021, time=2021-07-14, status=1, ipAttribution=)]
    2021-07-14 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2021-07-14 ms6000001833964428

    严格控糖,义不容辞

    0

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    2021-07-14 zhangxiang

    学习了,好

    0

拓展阅读

BMC Oral Health:美国成人糖尿病患者口腔护理与牙周炎和血糖控制的关系

研究表明治疗牙周炎可能有利于糖尿病患者的血糖控制。本研究的目的是研究口腔护理,特别是牙线和预防性牙齿护理,与牙周炎和血糖控制之间的关系,在美国有牙的糖尿病成年人中。

Cureus:刮治和根刨对慢性牙周炎患者唾液白介素-6水平和血糖控制的影响

2型糖尿病(DM)和牙周炎具有双向关系,牙周炎被认为是糖尿病的第六大并发症。本文目的是评价刮治和刨根术(SRP)对合并和不合并T2DM的CP患者唾液IL-6水平的影响及临床参数评价。

Nature Medicine:北京大学纪立农团队发现替西帕肽可显著改善血糖控制

该项3期SURPASS-AP-Combo试验的结果显示,在二甲双胍控制不充分的T2D患者中,每周使用tirzepatide可显著改善血糖控制。

JAMA子刊:青少年1型糖尿病患者实现临床目标与治疗方式的关系

对所有1型糖尿病患者来说,精确的终身糖尿病护理是一项挑战。

Cardiovasc Diabetol:1型糖尿病患者动脉硬化有关的血糖控制和糖基化参数

当前和平均10年HbA1c所反映的长期血糖暴露是T1D患者动脉硬化的关键预测因素,而与任何短期CGM参数均无相关性。

JAMA子刊:对于妊娠期糖尿病准妈妈,即使血糖缓慢控制到最优范围,难产、PICU等风险仍升高18%-42%!

JAMA Netw Open:妊娠糖尿病患者的血糖控制轨迹和围产期并发症的风险