Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study.
Patterns of weight change after the diagnosis of type 2 diabetes in Scotland and their relationship with glycaemic control, mortality and cardiovascular outcomes: a retrospective cohort study.
复制标题
DOI：
10.1136/bmjopen-2015-010836
复制
发表时间：
2016-07-26
期刊：
影响因子：
2.9
通讯作者：
Scottish Diabetes Research Network Epidemiology Group
中科院分区：
文献类型：
--
作者：
Aucott LS;Philip S;Avenell A;Afolabi E;Sattar N;Wild S;Scottish Diabetes Research Network Epidemiology Group
确定苏格兰患者诊断 2 型糖尿病 2 年后的体重变化模式，并检查这些变化与中期血糖、死亡率和心血管结局的关系。使用回顾性队列设计，获得了伦理批准，将苏格兰糖尿病护理数据库与入院和死亡率记录联系起来。 2002 年至 2006 年间诊断出的 29 316 名超重/肥胖患者被诊断为糖尿病，并提供了≥2 年的相关信息。随着时间的推移，体重记录提供了患者体内体重的变化和变化，糖化血红蛋白 (HbA1c) 提供了血糖控制的测量结果。诊断时的这些特征和人口统计学变量与死亡通知（诊断后 2-5 年）和心血管事件（诊断后 0-5 年）相关。到 2 年，36% 的患者体重减轻了 ≥2.5%。年龄增长、女性身份以及诊断时较高的体重指数与较大比例的体重减轻相关（p<0.001）。多变量模型显示，2 岁时血糖控制不足与基线年龄较年轻、男性、诊断时肥胖水平较低、体重增加或体重随体重变化变化保持稳定以及开始服用抗糖尿病药物有关。虽然体重变化本身与死亡率或心血管结局无关，但体重的主要变化与生存较差和心血管结局风险增加独立相关，剥夺也是如此。我们的结果表明，糖尿病诊断后早期体重减轻或体重稳定且体重变化很小，与更好的血糖控制有关，并且我们确定了减肥能力较差的群体。就死亡率和心血管结局而言，尽管 2 年体重变化是一个较弱的预测因素，但主要体重变异似乎是更相关的因素。
To determine weight change patterns in Scottish patients 2 years after diagnosis of type 2 diabetes and to examine these in association with medium-term glycaemic, mortality and cardiovascular outcomes. Using a retrospective cohort design, ethical approval was obtained to link the Scottish diabetes care database to hospital admission and mortality records. 29 316 overweight/obese patients with incident diabetes diagnosed between 2002 and 2006 were identified with relevant information for ≥2 years. Weight records over time provided intrapatient weight change and variation and glycated haemoglobin (HbA1c) gave measures of glycaemic control. These characteristics and demographic variables at diagnosis were linked with notifications of death (2–5 years after diagnosis) and cardiovascular events (0–5 year after diagnosis). By 2 years, 36% of patients had lost ≥2.5% of their weight. Increasing age, being female and a higher body mass index at diagnosis were associated with larger proportions of weight lost (p<0.001). Multivariable modelling showed that inadequate glycaemic control at 2 years was associated with being younger at baseline, being male, having lower levels of obesity at diagnosis, gaining weight or being weight stable with weight change variability, and starting antidiabetic medication. While weight change itself was not related to mortality or cardiovascular outcomes, major weight variability was independently associated with poorer survival and increased cardiovascular outcome risks, as was deprivation. Our results suggest that weight loss or being weight stable with little weight variability early after diabetes diagnosis, are associated with better glycaemic control and we identified groups less able to lose weight. With respect to mortality and cardiovascular outcomes, although weight change at 2 years was a weak predictor, major weight variability appeared to be the more relevant factor.