Earlier Onset of Complications in Youth With Type 2 Diabetes
Earlier Onset of Complications in Youth With Type 2 Diabetes
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DOI：
10.2337/dc13-0954
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发表时间：
2014-02-01
期刊：
影响因子：
16.2
通讯作者：
Sellers, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Dart, Allison B.;Martens, Patricia J.;Sellers, Elizabeth A.
目的评价青少年2型糖尿病并发症的发生风险。研究设计和方法在1986年至2007年间，从临床登记中确定了342名流行2型糖尿病青年（1-18岁）、1011名1型糖尿病青年和1710名非糖尿病对照青年，并与医疗记录相关联，使用ICD-9CM和ICD-10CA代码评估长期结果。结果青少年2型糖尿病患者出现并发症的风险增加（危险比1.47 [95% CI 1.02-2.12]）。显著的不良临床因素包括诊断时年龄（1.08 [1.02-2.12]），HbA(1c)(1.06[1.01-1.12])，以及令人惊讶的是，肾素-血管紧张素-醛固酮系统（RAAS）抑制剂的使用（1.75[1.27-2.41]）。HNF-1 G319S多态性在2型糖尿病队列中具有保护作用（0.58[0.34-0.99]）。Kaplan-Meier统计显示，在2型糖尿病队列中，肾脏和神经系统并发症的诊断较早，在诊断后5年内表现出来。视网膜病变未见差异。心脑血管疾病少见；然而，主要并发症（透析、失明或截肢）在2型糖尿病患者确诊10年后开始显现。患有2型糖尿病的青少年在所有方面的发病率都高于非糖尿病对照组的青少年，患任何血管疾病的风险总体上增加了6.15倍。结论青少年2型糖尿病比1型糖尿病更早出现并发症。较年轻的诊断年龄有潜在的保护作用，血糖控制是一个重要的可改变的危险因素。RAAS抑制剂使用与预后之间意外的不良关联可能是指征的混杂因素；然而，对年轻人的进一步评估是有必要的。
OBJECTIVETo evaluate the risk of complications in youth with type 2 diabetes.RESEARCH DESIGN AND METHODSPopulation-based cohorts of 342 youth (1-18 years of age) with prevalent type 2 diabetes, 1,011 youth with type 1 diabetes, and 1,710 nondiabetic control youth were identified between 1986 and 2007 from a clinical registry and linked to health care records to assess long-term outcomes using ICD-9CM and ICD-10CA codes.RESULTSYouth with type 2 diabetes had an increased risk of any complication (hazard ratio 1.47 [95% CI 1.02-2.12]). Significant adverse clinical factors included age at diagnosis (1.08 [1.02-2.12]), HbA(1c) (1.06 [1.01-1.12]), and, surprisingly, renin-angiotensin-aldosterone system (RAAS) inhibitor use (1.75 [1.27-2.41]). HNF-1 G319S polymorphism was protective in the type 2 diabetes cohort (0.58 [0.34-0.99]). Kaplan-Meier statistics revealed an earlier diagnosis of renal and neurologic complications in the type 2 diabetes cohort, manifesting within 5 years of diagnosis. No difference in retinopathy was seen. Cardiovascular and cerebrovascular diseases were rare; however, major complications (dialysis, blindness, or amputation) started to manifest 10 years after diagnosis in the type 2 diabetes cohort. Youth with type 2 diabetes had higher rates of all outcomes than nondiabetic control youth and an overall 6.15-fold increased risk of any vascular disease.CONCLUSIONSYouth with type 2 diabetes exhibit complications sooner than youth with type 1 diabetes. Younger age at diagnosis is potentially protective, and glycemic control is an important modifiable risk factor. The unexpected adverse association between RAAS inhibitor use and outcome is likely a confounder by indication; however, further evaluation in young people is warranted.