Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes.
Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes.
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DOI：
10.1136/bmjdrc-2020-001847
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发表时间：
2021-01
影响因子：
4.1
通讯作者：
Reynolds K
中科院分区：
文献类型：
--
作者：
An J;Nichols GA;Qian L;Munis MA;Harrison TN;Li Z;Wei R;Weiss T;Rajpathak S;Reynolds K
2型糖尿病(T2D)是一种常见的疾病，如果不进行治疗或处理不当，可能会导致不利的微血管和大血管并发症。我们在美国综合医疗系统中评估了新诊断为T2D的患者的微血管和大血管并发症的患病率和发生率。我们在2003至2014年间新诊断为T2D的患者中进行了一项回顾性队列研究。我们评估了13种并发症，包括慢性肾脏疾病(CKD)、心血管疾病(CVD)和2018年前的全因死亡率。采用多变量COX比例风险模型研究并发症的相关因素。我们确定了135 199名发生T2D事件的患者。平均年龄为58岁，其中48%是女性。在T2D诊断时，CKD的患病率最高(12.3%，95%CI为12.2%~12.5%)，而CVD的患病率最低，为3.3%(95%CI 3.2%~3.3%)。发生T2D并发症的中位时间为3.0至5.2年。T2D并发症的高发生率(95%CI)包括周围神经病变(26.9，95%CI 26.5~27.3/1000人年)、CKD(21.2，95%CI 20.9~21.6/1000人年)和CVD(11.9，95%CI 11.7~12.2/1000人年)。T2D并发症的5年发病率按诊断年限的趋势随着时间的推移而降低(p值<；0.001)。年龄较大、非西班牙裔白人/民族、性别、A1C较高、吸烟和高血压与CKD和CVD发病率增加相关。虽然T2D并发症的发生率在最近几年(2010-2014)较低，但相当大比例的患者在T2D诊断时有并发症。早期预防性治疗以及控制可改变的因素可能有助于延缓T2D并发症的发展和进展。
Type 2 diabetes (T2D) is a common condition that, if left untreated or poorly managed, can lead to adverse microvascular and macrovascular complications. We estimated the prevalence and incidence of microvascular and macrovascular complications among patients newly diagnosed with T2D within a US integrated healthcare system. We conducted a retrospective cohort study among patients newly diagnosed with T2D between 2003 and 2014. We evaluated 13 complications, including chronic kidney disease (CKD), cardiovascular disease (CVD), and all-cause mortality through 2018. Multivariable Cox proportional hazards models were used to study factors associated with complications. We identified 135 199 patients with incident T2D. The mean age was 58 years, and 48% were women. The prevalence of CKD was the highest of the complications at the time of T2D diagnosis (prevalence=12.3%, 95% CI 12.2% to 12.5%), while the prevalence of CVD was among the lowest at 3.3% (95% CI 3.2% to 3.3%). The median time to incidence of a T2D complication ranged from 3.0 to 5.2 years. High incidence rates (95% CI) of T2D complications included peripheral neuropathy (26.9, 95% CI 26.5 to 27.3 per 1000 person-years (PY)), CKD (21.2, 95% CI 20.9 to 21.6 per 1000 PY), and CVD (11.9, 95% CI 11.7 to 12.2 per 1000 PY). The trend of 5-year incidence rates of T2D complications by diagnosis year decreased over time (p value<0.001). Older age, non-Hispanic white race/ethnicity, sex, higher A1C, smoking, and hypertension were associated with increased CKD and CVD incidence. Though incidence rates of T2D complications were lower in more recent years (2010–2014), a significant proportion of patients had complications at T2D diagnosis. Earlier preventive therapies as well as managing modifiable factors may help delay the development and progression of T2D complications.
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影响因子：
4.3
作者：
Kajiwara A;Kita A;Saruwatari J;Miyazaki H;Kawata Y;Morita K;Oniki K;Yoshida A;Jinnouchi H;Nakagawa K
通讯作者：
Nakagawa K
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120.7
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Karter, AJ;Ferrara, A;Selby, JV
通讯作者：
Selby, JV
影响因子：
120.7
作者：
Fox, CS;Coady, S;Savage, PJ
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Savage, PJ