2015年第75屆美國糖尿病協會(ADA)科學年會在美國波士頓召開。上海市閔行區疾控中心團隊的一項研究入選ADA2015年會普通壁報專場(GeneralPosterSession)。該研究發現中國2型糖尿病患者中評估隨訪期間空腹血糖(PFG)變異與全因死亡率之間存在相關性。以下是研究摘要譯文。
2015年第75屆美國糖尿病協會(ADA)科學年會在美國波士頓召開。上海市閔行區疾控中心團隊的一項研究入選ADA2015年會普通壁報專場(GeneralPosterSession)。該研究發現中國2型糖尿病患者中評估隨訪期間空腹血糖(PFG)變異與全因死亡率之間存在相關性。以下是研究摘要譯文。
目的：與糖尿病相關的遠期並發症包括心血管和腎髒疾病，這些並發症是全球導致糖尿病患者死亡的主要原因。糖尿病患者在隨訪期間血糖變異的重要性尚不清楚。該研究旨在中國2型糖尿病患者中評估隨訪期間空腹血糖(PFG)變異與全因死亡率之間的關聯。
方法：在2007年1月~2007年12月間共納入6847例2型糖尿病患者。這些患者第一年至少有4次空腹血糖記錄，每年進行常規隨訪，隨訪至2014年。通過空腹血糖標準差和變異係數(FPG-SD、FPG-CV)計算血糖變異，采用Cox比例風險回歸模型評估在校正其他相關危險因素後血糖變異對全因死亡率的影響。
結果：在平均隨訪6.2年間，共有818例患者(占總人數11.941%)死亡，死亡率為19.43/1000人-年。平均FPG-SD為0.91mmol/L，平均FPG-CV為0.12，根據FPG-SD和FPG-CV水平各自分為從低到高四個分位。經多變量校正後，相比FPG-SD第一分位(<0.37mmol/L)，FPG-SD第二分位(0.37~0.66 mmol/L)、第三分位(0.66~1.15 mmol/L)、第四分位(>1.15mmol/L)的風險比分別為0.90 (0.74, 1.11)、1.00(0.84, 1.26)和1.39(1.15, 1.68)(p分別=0.001);相比FPG-CV第一分位(<0.05 mmol/L)，FPG-CV第二分位(0.56~0.10mmol/L)、第三分位(0.10 ~0.15mmol/L)、第四分位(>0.15mmol/L)的風險比分別為 0.89(0.73, 1.10)、1.06(0.87, 1.30)和1.36(1.12, 1.64)(p分別=0.002);即隨著FPG-SD和FPG-CV的增加，全因死亡風險顯著增加。
結論：高水平的血糖變異與全因死亡率增加相關，FPG-SD和FPG-CV可能是中國2型糖尿病患者全因死亡的獨立預測因素。
【研究摘要】
| Abstract Number: | 1715-P |
| Title: | The Association between Visit-to-Visit Variability of Fasting Plasma Glucose and All-Cause Mortality in Chinese Type 2 Diabetic Patients |
| Authors: | YINAN LIU, BAODONG YAO, HONG FANG, YUJIE YAN, YANPING ZHAO, YUE CHEN, Shanghai, China, Ottawa, ON, Canada |
| Abstract: | Diabetes is associated with long-term complications that include cardiovascular and kidney disease and is an important cause of mortality worldwide. The importance of visit-to-visit glycemic variability in diabetes remains unclear. This study aimed to assess the relationship between visit-to-visit variability in fasting plasma glucose (FPG) and all-cause mortality in Chinese type 2 diabetic patients. From Jan 2007 to Dec 2007, 6,847 type 2 diabetic patients with at least four records of FPG in the first year during regular follow-up were included in this analysis. They were followed through Nov 2014. The data were obtained from Electric Health Recording (EHR) of Shanghai Minhang District of China. Glycemic variation were calculated using standard deviation and coefficient of variation of FPG (FPG-SD and FPG-CV respectively), and Cox proportional hazards regression model was applied to estimate the effect on all-cause mortality adjusting for other related risk factors. 11.94% (n=818) of the cohort died during an average of 6.2 years follow-up, resulting in a mortality rate of 19.43 per 1000 person-years. The mean FPG-SD was 0.91 mmol/L. After multivariate adjustment, hazard ratios for the second (0.37 to 0.66 mmol/L), third (0.66 to 1.15 mmol/L) and fourth (>1.15 mmol/L) versus first FPG-SD quartile (<0.37 mmol/L) were 0.90 (0.74, 1.11), 1.00 (0.84, 1.26) and 1.39 (1.15, 1.68), respectively (p=0.001). The mean FPG-CV was 0.12. Multivariable hazard ratios for the second (0.56 to 0.10), third (0.10 to 0.15) and fourth (>0.15) versus first FPG-CV quartile (<0.05) were 0.89 (0.73, 1.10), 1.06 (0.87, 1.30) and 1.36 (1.12, 1.64) (p=0.002). High level of glycemic variability is associated with an increase of all-cause mortality, and both FPG-SD and FPG-CV may be independent predictors of all-cause mortality in Chinese type 2 diabetic patients. |
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