Effect of diabetes duration and glycaemic control on 14-year cause-specific mortality in Mexican adults: a blood-based prospective cohort study.
Effect of diabetes duration and glycaemic control on 14-year cause-specific mortality in Mexican adults: a blood-based prospective cohort study.
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DOI：
10.1016/s2213-8587(18)30050-0
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发表时间：
2018-06
期刊：
影响因子：
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通讯作者：
Emberson JR
中科院分区：
文献类型：
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作者：
Herrington WG;Alegre-Díaz J;Wade R;Gnatiuc L;Ramirez-Reyes R;Hill M;Solano-Sánchez M;Baigent C;Lewington S;Collins R;Tapia-Conyer R;Peto R;Kuri-Morales P;Emberson JR
在35-74岁的墨西哥成年人中，糖尿病至少占所有死亡人数的三分之一，超额死亡率主要是由于血管疾病、肾脏疾病、感染和急性糖尿病危象。我们的目的是分析糖尿病病程和血糖控制对这些原因的死亡率比(RR)的影响，并评估与未诊断糖尿病的原因特定死亡率的相关性。在1998年4月14日至2004年9月28日期间，墨西哥城约10万名年龄在35岁或以上的女性和50名 000男性被招募到一项基于血液的前瞻性研究中，并跟踪调查到2016年1月1日的死因特定死亡率。在招募时报告糖尿病以外的任何慢性病的参与者以及那些丢失HbA1c或糖尿病病程数据的参与者被排除在外。我们使用COX模型估计未确诊或既往诊断的糖尿病(几乎所有2型糖尿病)与血管疾病、肾脏疾病和感染的死亡风险之间的关系，探索在既往诊断为糖尿病的患者中糖尿病病程(5年，≥5年至10年，或≥10年)与糖化血红蛋白(9%，≥9%至11%，或≥11%)的独立相关性。我们还估计了在招募时无糖尿病的参与者中HbA1c与死亡率的相关性。 受试者年龄35-74岁，资料完整，无其他慢性病。16名 940人(13%)以前诊断为糖尿病，6,541人(5%)有未诊断的糖尿病，110名 181人(82%)没有糖尿病。在既往诊断为糖尿病的参与者中，血糖控制较差(中位数HbA1c 8.9%[IQR7.0-10.9])，在招募时病程较长的患者中更差。与非糖尿病组比较，未确诊糖尿病组35~74岁合并血管、肾脏或感染性疾病的死亡相对危险度分别为3.0(95%CI 2·7~3·4)、4·5(4·0~5·0)、6·6(6·1~7·1)和11·7(10·7~12·7)。HbA1c<9%者死亡RR值为5·2(4·8~5·7)，HbA1c<9%~<11%者为6·8(6·2~7·4)，HbA1c>11%者为10·5(9·7~11·5)。除急性血糖危象外，糖尿病与其他死亡原因的组合没有很强的相关性。在没有糖尿病的参与者中，较高的HbA1c与死亡率没有正相关。在墨西哥，与糖尿病密切相关的原因的死亡率随着糖尿病病程的延长而急剧增加，在血糖控制不佳的人中甚至更高。推迟2型糖尿病的发病，以及改进其治疗，对于降低墨西哥成年人的过早死亡率至关重要。惠康信托基金、墨西哥卫生部、墨西哥国家科学技术委员会、英国癌症研究中心、英国心脏基金会和英国医学研究委员会人口健康研究单位。
Diabetes is a cause of at least a third of all deaths in Mexican adults aged 35–74 years, with the excess mortality due mainly to vascular disease, renal disease, infection, and acute diabetic crises. We aimed to analyse the effect of diabetes duration and glycaemic control on death rate ratios (RRs) for these causes and to assess the relevance to cause-specific mortality of undiagnosed diabetes. About 100 000 women and 50 000 men aged 35 years or older from Mexico City were recruited into a blood-based prospective study between April 14, 1998, and Sept 28, 2004, and followed up until Jan 1, 2016, for cause-specific mortality. Participants who, at recruitment, reported any chronic disease other than diabetes and those who had missing data for HbA1c or diabetes duration were excluded. We used Cox models to estimate the associations of undiagnosed or previously diagnosed diabetes (almost all type 2) with risk of mortality from vascular disease, renal disease, and infection, exploring among those with previously diagnosed diabetes the independent relevance of diabetes duration (<5 years, ≥5 to <10 years, or ≥10 years) and HbA1c (<9%, ≥9% to <11%, or ≥11%). We also estimated the association of HbA1c with mortality in participants without diabetes at recruitment. 133 662 participants were aged 35–74 years and had complete data and no other chronic disease. 16 940 (13%) had previously diagnosed diabetes, 6541 (5%) had undiagnosed diabetes, and 110 181 (82%) had no diabetes. Among participants with previously diagnosed diabetes, glycaemic control was poor (median HbA1c 8·9% [IQR 7·0–10·9]), and was worse in those with longer duration of disease at recruitment. Compared with participants without diabetes, the death RRs at ages 35–74 years for the combination of vascular, renal, or infectious causes were 3·0 (95% CI 2·7–3·4) in those with undiagnosed diabetes, 4·5 (4·0–5·0) for the 5042 participants with a diabetes duration of less than 5 years, 6·6 (6·1–7·1) for the 7713 participants with a duration of 5 years to less than 10 years, and 11·7 (10·7–12·7) for the 4185 participants with a duration of at least 10 years. Similarly, the death RRs were 5·2 (4·8–5·7) for those with HbA1c less than 9%, 6·8 (6·2–7·4) for those with HbA1c of 9% to less than 11%, and 10·5 (9·7–11·5) for those with HbA1c of at least 11%. Diabetes was not strongly associated with the combination of deaths from other causes apart from acute glycaemic crises. Among participants without diabetes, higher HbA1c was not positively related to mortality. In Mexico, the rates of death from causes strongly associated with diabetes increased steeply with duration of diabetes and were higher still among people with poor glycaemic control. Delaying the onset of type 2 diabetes, as well as improving its treatment, is essential to reduce premature adult mortality in Mexico. Wellcome Trust, the Mexican Health Ministry, the Mexican National Council of Science and Technology, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council Population Health Research Unit.