Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014.
Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014.
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DOI：
10.1016/s2213-8587(18)30027-5
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Gregg EW
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文献类型：
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作者：
Ali MK;Bullard KM;Saydah S;Imperatore G;Gregg EW
人们对糖尿病前期的“标签”存在争议。使用连续的横断面国家健康和营养检查调查（1988-1994，1999-2004，2005-2010，2011-2014），我们检查了美国成年糖尿病前期患者心肾负担的患病率，并与其他血糖组进行了比较。在25813名未怀孕的成年人中，我们将糖尿病分类为：自我报告诊断的糖尿病或没有自我报告的糖尿病，空腹血糖（FPG）=100- 125 mg/dl或糖化血红蛋白（HbA 1c）=5.7-6.4%（糖尿病前期），FPG≥ 126 mg/dl或HbA 1c ≥6.5%（未诊断的糖尿病），或FPG<100 mg/dl且HbA 1c <5.7%（正常）。我们使用不同的糖尿病前期定义（FPG=110- 125 mg/dl或HbA 1c =5.7- 6.4%，FPG=110- 125 mg/dl或HbA 1c =6.0- 6.4%，以及FPG=100- 125 mg/dl和HbA 1c =5.7-6.4%）重复分析。随着时间的推移，我们估计了各组高血压和血脂异常的患病率;其中，我们估计了治疗和实现护理目标的比例。按组，我们估计了当前吸烟、既往吸烟和从不吸烟;平均10年心血管事件风险（使用Fragrance、UKPDS和ASCVD估计值）;白蛋白尿（平均值和白蛋白：肌酐比值≥ 30 mg/g），估计的肾小球滤过率（eGFR;平均值和<60 ml/min/1.73 m2），以及心肌梗死和卒中的患病率。在2011-2014年，>36%的糖尿病前期成人患有高血压; >50%患有血脂异常; >24%吸烟; >11%患有蛋白尿或eGFR降低;平均十年事件风险约为5- 6%。从1988-1994年到2011-2014年，患有前驱糖尿病的成年人经历了高血压的显著增加（+9-10个百分点[ppt]）;血脂异常无变化;吸烟减少（范围：-5.6至-9.8ppt）;治疗增加（+27.2ppt [BP]; +33.6ppt [血脂]）和目标实现（+36.2ppt [BP]; +31.8ppt [血脂]）;心血管风险降低（范围：-1.9至4.9ppt）;但蛋白尿、eGFR降低、心肌梗死和卒中无变化。所有糖尿病前期定义的患病率和模式是一致的。与糖尿病前期的成年人相比，诊断为糖尿病的成年人在心肾风险治疗方面有更大的改善，除了吸烟没有下降。在过去的25年中，无论使用何种定义，心肾风险和疾病在糖尿病前期成人中仍然非常普遍。识别糖尿病前期可能为降低心肾风险提供机会。
There is controversy over “labelling” people with prediabetes. Using serial cross-sectional National Health and Nutrition Examination Surveys (1988–1994, 1999–2004, 2005–2010, 2011–2014), we examined prevalence of cardio-renal burdens in U.S. adults with prediabetes over time and compared patterns with other glycemic groups. Among 25813 non-pregnant adults, we categorized glycemia as: self-reported diagnosed diabetes or no self-reported diabetes with Fasting Plasma Glucose (FPG)=100–125mg/dl or glycated hemoglobin (HbA1c)=5.7–6.4% (prediabetes), FPG≥126mg/dl or HbA1c≥6.5% (undiagnosed diabetes), or FPG<100mg/dl and HbA1c<5.7% (normal glycemia). We repeated analyses using varying definitions of prediabetes (FPG=110–125mg/dl or HbA1c=5.7–6.4%, FPG=110–125mg/dl or HbA1c=6.0–6.4%, and FPG=100–125mg/dl and HbA1c=5.7–6.4%). For each group over time, we estimated prevalence of hypertension and dyslipidemia; among those, we estimated proportions treated and achieving care goals. By group, we estimated current, former, and never-smoking; mean ten-year cardiovascular event risk (using Framingham, UKPDS, and ASCVD estimators); albuminuria (mean and albumin:creatinine ratio≥30mg/g), estimated glomerular filtration rate (eGFR; mean and <60ml/min/1.73m2), and prevalence of myocardial infarction and stroke. In 2011–2014, >36% adults with prediabetes were hypertensive; >50% had dyslipidemia; >24% smoked; >11% had albuminuria or reduced eGFR; and average ten-year event risk was approximately 5–6%. From 1988–1994 to 2011–2014, adults with prediabetes experienced significant increases in hypertension (+9–10percentage points [ppt]); no change in dyslipidemia; declines in smoking (range: −5.6 to −9.8ppt); increases in treatment (+27.2ppt [BP]; +33.6ppt [lipids]) and goal achievement (+36.2ppt [BP]; +31.8ppt [lipids]); declines in cardiovascular risk (range: −1.9 to −4.9ppt); but no change in albuminuria, reduced eGFR, myocardial infarction, and stroke. Prevalence and patterns were consistent across all prediabetes definitions examined. Compared to adults with prediabetes, adults with diagnosed diabetes experienced larger improvements in cardio-renal risk treatments, except smoking did not decline. Over 25 years, cardio-renal risks and disease remained highly prevalent in adults with prediabetes, regardless of definitions used. Identifying prediabetes may open opportunities for cardio-renal risk reduction.