The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study).
The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study).
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DOI：
10.2337/dc17-1144
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发表时间：
2019-03
期刊：
影响因子：
16.2
通讯作者：
Karter AJ
中科院分区：
文献类型：
--
作者：
Laiteerapong N;Ham SA;Gao Y;Moffet HH;Liu JY;Huang ES;Karter AJ
检验早期血糖控制对糖尿病并发症和死亡的遗留效应。
这项针对新诊断为2型糖尿病且存活10年（1997 - 2013年，平均随访13.0年，N = 34737）的管理式医疗患者的队列研究，检验了在早期不同暴露时间段（0 - 1年、0 - 2年、0 - 3年、0 - 4年、0 - 5年、0 - 6年和0 - 7年）内糖化血红蛋白（HbA1c）<6.5%（<48 mmol/mol）、6.5% - <7.0%（48 - <53 mmol/mol）、7.0% - <8.0%（53 - <64 mmol/mol）、8.0% - <9.0%（64 - <75 mmol/mol）或≥9.0%（≥75 mmol/mol）与未来发生微血管（终末期肾病、严重眼病、截肢）和大血管（中风、心脏病/心力衰竭、血管疾病）事件以及死亡之间的关联，并对人口统计学特征、风险因素、合并症以及后期的HbA1c进行了调整。
与0 - 1年早期暴露期HbA1c <6.5%（<48 mmol/mol）相比，HbA1c水平≥6.5%（≥48 mmol/mol）与微血管和大血管事件增加相关（例如，HbA1c 6.5% - <7.0%[48 - <53 mmol/mol]，微血管：风险比1.204[95%置信区间1.063 - 1.365]），HbA1c水平≥7.0%（≥53 mmol/mol）与死亡率增加相关（例如，HbA1c 7.0% - <8.0%[53 - <64 mmol/mol]：1.290[1.104 - 1.507]）。更长时间暴露于HbA1c水平≥8.0%（≥64 mmol/mol）与微血管事件和死亡风险增加相关。
在新诊断糖尿病且存活10年的患者中，诊断后第1年HbA1c水平≥6.5%（≥48 mmol/mol）与更差的预后相关。对新诊断患者可能需要立即进行强化治疗，以避免糖尿病并发症和死亡的不可挽回的长期风险。
To examine for a legacy effect of early glycemic control on diabetic complications and death. This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997–2013, average follow-up 13.0 years, N = 34,737) examined associations between HbA1c <6.5% (<48 mmol/mol), 6.5% to <7.0% (48 to <53 mmol/mol), 7.0% to <8.0% (53 to <64 mmol/mol), 8.0% to <9.0% (64 to <75 mmol/mol), or ≥9.0% (≥75 mmol/mol) for various periods of early exposure (0–1, 0–2, 0–3, 0–4, 0–5, 0–6, and 0–7 years) and incident future microvascular (end-stage renal disease, advanced eye disease, amputation) and macrovascular (stroke, heart disease/failure, vascular disease) events and death, adjusting for demographics, risk factors, comorbidities, and later HbA1c. Compared with HbA1c <6.5% (<48 mmol/mol) for the 0-to-1-year early exposure period, HbA1c levels ≥6.5% (≥48 mmol/mol) were associated with increased microvascular and macrovascular events (e.g., HbA1c 6.5% to <7.0% [48 to <53 mmol/mol] microvascular: hazard ratio 1.204 [95% CI 1.063–1.365]), and HbA1c levels ≥7.0% (≥53 mmol/mol) were associated with increased mortality (e.g., HbA1c 7.0% to <8.0% [53 to <64 mmol/mol]: 1.290 [1.104–1.507]). Longer periods of exposure to HbA1c levels ≥8.0% (≥64 mmol/mol) were associated with increasing microvascular event and mortality risk. Among patients with newly diagnosed diabetes and 10 years of survival, HbA1c levels ≥6.5% (≥48 mmol/mol) for the 1st year after diagnosis were associated with worse outcomes. Immediate, intensive treatment for newly diagnosed patients may be necessary to avoid irremediable long-term risk for diabetic complications and mortality.
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影响因子：
16.2
作者：
Karter AJ;Nundy S;Parker MM;Moffet HH;Huang ES
通讯作者：
Huang ES
影响因子：
158.5
作者：
Holman, Rury R.;Paul, Sanjoy K.;Neil, H. Andrew W.
通讯作者：
Neil, H. Andrew W.
影响因子：
3
作者：
Laiteerapong N;Karter AJ;Moffet HH;Cooper JM;Gibbons RD;Liu JY;Gao Y;Huang ES
通讯作者：
Huang ES
影响因子：
120.7
作者：
Karter, AJ;Ferrara, A;Selby, JV
通讯作者：
Selby, JV
影响因子：
2.8
作者：
Blumenthal, Karen J.;Larkin, Mary E.;Grant, Richard W.
通讯作者：
Grant, Richard W.