Impact of glycaemic control, hypertension and insulin treatment on general and cause-specific mortality: an Italian population-based cohort of type II (non-insulin-dependent) diabetes mellitus
Impact of glycaemic control, hypertension and insulin treatment on general and cause-specific mortality: an Italian population-based cohort of type II (non-insulin-dependent) diabetes mellitus
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DOI：
10.1007/s001250051154
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发表时间：
1999-03-01
期刊：
影响因子：
8.2
通讯作者：
Pagano, G
中科院分区：
文献类型：
--
作者：
Bruno, G;Merletti, F;Pagano, G
本研究的目的是评估糖尿病和相关变量（空腹血糖、血压、抗糖尿病治疗、体重指数）对意大利 II 型（非胰岛素依赖）糖尿病人群（主要包括老年患者）的一般死亡率和特定原因死亡率的影响。 1988 年确定了 II 型糖尿病患者（n = 1967），确定的估计完整性为 80%。 1995 年，对该队列进行了死亡率随访（完整性为 98%），总计 11153 人年。观察到的死亡人数和预期死亡人数分别为 577 人和 428.7 人，标准化死亡率 (SMR) 为 1.35 (95% CI 1.24-1.46)。最常见的根本死因是恶性肿瘤、缺血性心脏病和脑血管疾病，分别占死亡人数的18%、17.8%和17.5%。心血管疾病作为一个整体（国际疾病分类 ICD-9 390-459）占 577 例死亡中的 260 例（SMR 1.21，95% CI 1.07-1.36）。在内部分析中，一般死亡率最重要的预测因素是胰岛素治疗（相对风险[RR] 1.72，95% CI 1.19-2.49）和空腹血糖大于8.89 mmol/l（[RR] 1.29，95% CI 1.04-1.60），而心血管疾病最重要的预测因素是胰岛素治疗和高血压。总之，这项基于人群的研究表明：1) II 型糖尿病死亡率略高于 35%，2) 基线空腹血糖高于 8.89 mmol/l 的受试者死亡率增加 30%，3) 高血压患者死于心血管疾病的风险增加 40%。
The aims of this study were to assess the impact of diabetes and associated variables (fasting plasma glucose, blood pressure, antidiabetic treatment, body mass index) on general and cause-specific mortality in an Italian population-based cohort with Type II (non-insulin-dependent) diabetes mellitus, comprising mainly elderly patients. The patients (n = 1967) who had Type II diabetes were identified in 1988 with an 80 % estimated completeness of ascertainment. In 1995, a mortality follow-up (98 % completeness) of the cohort was done amounting to a total of 11153 person-years. Observed and expected number of deaths were 577 and 428.7, respectively, giving a standardized mortality ratio (SMR) of 1.35 (95% CI 1.24-1.46). The most common underlying causes of death were malignant neoplasm, ischaemic heart disease and cerebrovascular diseases, which accounted for 18 %, 17.8 % and 17.5 % of deaths, respectively. Cardiovascular disease as a whole (international classification of disease ICD-9 390-459) accounted for 260 of 577 deaths (SMR 1.21, 95 % CI 1.07-1.36). In internal analysis, the most important predictors of general mortality were insulin-treatment (relative risk [RR] 1.72, 95% CI 1.19-2.49) and a fasting plasma glucose greater than 8.89 mmol/l ([RR] 1.29, 95 % CI 1.04-1.60), whereas the most important predictors of cardiovascular diseases were insulin-treatment and hypertension. In conclusion, this population-based study showed: 1) slight mortality excess of 35 % in Type II diabetes being associated with 2) a 30 % increased mortality in subjects with baseline fasting glucose greater than 8.89 mmol/l and 3) a 40 % increased risk of death from cardiovascular diseases in hypertensive patients.