Metabolic phenotypes, vascular complications, and premature deaths in a population of 4,197 patients with type 1 diabetes.
Metabolic phenotypes, vascular complications, and premature deaths in a population of 4,197 patients with type 1 diabetes.
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DOI：
10.2337/db08-0332
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发表时间：
2008-09
期刊：
影响因子：
7.7
通讯作者：
FinnDiane Study Group
中科院分区：
文献类型：
--
作者：
Mäkinen VP;Forsblom C;Thorn LM;Wadén J;Gordin D;Heikkilä O;Hietala K;Kyllönen L;Kytö J;Rosengård-Bärlund M;Saraheimo M;Tolonen N;Parkkonen M;Kaski K;Ala-Korpela M;Groop PH;FinnDiane Study Group
目的——血糖控制不佳、甘油三酯升高和蛋白尿与糖尿病血管并发症相关。然而，很少有研究调查代谢标志物、糖尿病肾病、视网膜病变、高血压、肥胖和死亡率之间的综合关联。这里的目标是揭示 FinnDiane 数据集中以前未检测到的临床诊断和生物化学之间的关联模式。研究设计和方法——在基线时，收集了 2,173 名男性和 2,024 名女性 1 型糖尿病患者的临床记录、血清和 24 小时尿液样本。数据通过自组织图进行分析，这是一种无监督模式识别算法，可根据患者的多变量生化特征生成患者的二维布局。随访时，将结果与 6.5 年期间的全因死亡率（295 例死亡）进行比较。结果——死亡率最高与晚期肾病相关。其他危险因素包括 1) 胰岛素抵抗、腹部肥胖、高胆固醇、甘油三酯和低 HDL2 胆固醇，以及 2) 老年患者的高脂联素和高 LDL 胆固醇。男性的最高人口调整死亡风险为 10.1 倍（95% CI 7.3-13.1），女性为 10.7 倍（7.9-13.7）。对于血糖控制良好和高 HDL2 胆固醇的情况以及低胆固醇情况和糖尿病病程较短的情况，观察到不显着的风险。结论——自组织图谱分析能够进行详细的风险评估，描述已知风险因素和并发症之间的关联，并揭示经典方法难以检测的统计模式。结果还表明，没有不良代谢表型的糖尿病本身不会导致死亡率增加。
OBJECTIVE—Poor glycemic control, elevated triglycerides, and albuminuria are associated with vascular complications in diabetes. However, few studies have investigated combined associations between metabolic markers, diabetic kidney disease, retinopathy, hypertension, obesity, and mortality. Here, the goal was to reveal previously undetected association patterns between clinical diagnoses and biochemistry in the FinnDiane dataset. RESEARCH DESIGN AND METHODS—At baseline, clinical records, serum, and 24-h urine samples of 2,173 men and 2,024 women with type 1 diabetes were collected. The data were analyzed by the self-organizing map, which is an unsupervised pattern recognition algorithm that produces a two-dimensional layout of the patients based on their multivariate biochemical profiles. At follow-up, the results were compared against all-cause mortality during 6.5 years (295 deaths). RESULTS—The highest mortality was associated with advanced kidney disease. Other risk factors included 1) a profile of insulin resistance, abdominal obesity, high cholesterol, triglycerides, and low HDL2 cholesterol, and 2) high adiponectin and high LDL cholesterol for older patients. The highest population-adjusted risk of death was 10.1-fold (95% CI 7.3–13.1) for men and 10.7-fold (7.9–13.7) for women. Nonsignificant risk was observed for a profile with good glycemic control and high HDL2 cholesterol and for a low cholesterol profile with a short diabetes duration. CONCLUSIONS—The self-organizing map analysis enabled detailed risk estimates, described the associations between known risk factors and complications, and uncovered statistical patterns difficult to detect by classical methods. The results also suggest that diabetes per se, without an adverse metabolic phenotype, does not contribute to increased mortality.
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影响因子：
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影响因子：
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作者：
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DOI：
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