Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes
Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes
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DOI：
10.1371/journal.pone.0225230
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发表时间：
2019-11-27
期刊：
影响因子：
3.7
通讯作者：
Koster-Rasmussen, Rasmus
中科院分区：
文献类型：
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作者：
Rozing, Maarten P.;Moller, Anne;Koster-Rasmussen, Rasmus
分析2型糖尿病（2型DM）诊断后前6年内HbA（1c）变化与此后13年内微血管和大血管发病率和死亡率之间的关系。这是一项在丹麦进行的全科糖尿病护理（DCGP）随机对照试验干预组受试者中进行的观察性研究。494名40岁及以上新诊断的2型糖尿病患者在6年的干预期间进行了3次或3次以上的HbA（1c）测量。根据糖尿病诊断后1 - 6年的HbA（1c）测量值拟合的回归线，通过诊断后1年的HbA（1c）水平和回归线的斜率来表征血糖控制。结果是糖尿病诊断后6 - 19年内糖尿病相关的发病率和死亡率。在校正的考克斯回归模型中评估HbA（1c）变化（回归线的斜率）与临床结局之间的相关性。第1年HbA（1c）水平中位数为60（IQR：52-71）mmol/mol或（7.65（IQR：6.91-8.62）%）。诊断一年后较高的HbA（1c）水平与后期糖尿病相关发病率和死亡率的较高风险相关。糖尿病诊断后前6年内HbA（1c）的增加与后期微血管并发症相关（每年HbA（1c）每增加1.1 mmol/mol或0.1%的HR; 95% CI）= 1.14; 1.05-1.24）。HbA（1c）的变化不能预测任何糖尿病相关终点、全因死亡率、糖尿病相关死亡率、心肌梗死、卒中或外周血管疾病的综合结局。我们的结论是，在糖尿病诊断后的前6年内，血糖控制不佳是随后13年随访期间微血管并发症的独立危险因素，但不是死亡率或大血管并发症的危险因素。
To analyze the association between change in HbA(1c) during the first 6 years after diagnosis of Type 2 diabetes mellitus (Type 2 DM) and incident micro- and macrovascular morbidity and mortality during 13 years thereafter. This is an observational study of the participants in the intervention arm of the randomized controlled trial Diabetes Care in General Practice (DCGP) in Denmark. 494 newly diagnosed persons with Type 2 DM aged 40 years and over with three or more measurements of HbA(1c) during six years of intervention were included in the analyses. Based on a regression line, fitted through the HbA(1c)-measurements from 1 to 6 years after diabetes diagnosis, glycaemic control was characterized by the one-year level of HbA(1c) after diagnosis, and the slope of the regression line. Outcomes were incident diabetes-related morbidity and mortality from 6 to 19 years after diabetes diagnosis. The association between change in HbA(1c) (the slope of the regression line) and clinical outcomes were assessed in adjusted Cox regression models. The median HbA(1c) level at year one was 60 (IQR: 52-71) mmol/mol or (7.65 (IQR: 6.91-8.62) %). Higher HbA(1c) levels one year after diagnosis were associated with a higher risk of later diabetes-related morbidity and mortality. An increase in HbA(1c) during the first 6 years after diabetes diagnosis was associated with later microvascular complications (HR per 1.1 mmol/mol or 0.1% point increase in HbA(1c) per year; 95% CI) = 1.14; 1.05-1.24). Change in HbA(1c) did not predict the aggregate outcome 'any diabetes-related endpoint, all-cause mortality, diabetes-related mortality, myocardial infarction, stroke, or peripheral vascular diseases. We conclude that suboptimal development of glycaemic control during the first 6 years after diabetes diagnosis was an independent risk factor for microvascular complications during the succeeding 13-year follow-up, but not for mortality or macrovascular complications.