Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study
Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study
复制标题
DOI：
10.1016/s0140-6736(09)61969-3
复制
发表时间：
2010-02-06
期刊：
影响因子：
168.9
通讯作者：
Poole, Chris D.
中科院分区：
文献类型：
--
作者：
Currie, Craig J.;Peters, John R.;Poole, Chris D.
背景2型糖尿病患者干预研究的结果引起了人们对血糖浓度正常的安全性的关注。我们评估生存率作为HbA（1C）在2型diabetes.Methods两个队列的患者年龄在50岁及以上的2型糖尿病患者的功能从英国全科医学研究数据库1986年11月至2008年11月。我们确定了27965例患者，他们的治疗已经从口服单药治疗强化为口服降糖药联合治疗，20005例患者已经改变为包括胰岛素在内的治疗方案。排除继发于其他原因的糖尿病患者。全因死亡率是主要结局。年龄、性别、吸烟状况、胆固醇、心血管风险和一般发病率被确定为重要的混杂因素，考克斯生存模型针对这些因素进行了相应的调整。（中位HbA（1c）7.5%，IQR 7.5-7.6%），最低HbA（1c）十分位数中全因死亡率的校正风险比（HR）（6.4%，6.1-6.6）为1.52（95% CI 1.32-1.76），最高HbA（1c）十分位数（中位数10.5%，IQR 10.1-11.2%）为1.79（95% CI 1.56-2.06）。结果显示总体呈U形相关，HbA（1c）约为7.5%时HR最低。以胰岛素为基础的治疗方案（2834例死亡）与联合口服药物（2035例）患者的全因死亡率的HR为1.49（95%CI 1.39-1.59）。解释低和高平均HbA（1c）值与全因死亡率和心脏事件增加相关。如果得到证实，糖尿病指南可能需要修订，以包括最低HbA（1c）值。
Background Results of intervention studies in patients with type 2 diabetes have led to concerns about the safety of aiming for normal blood glucose concentrations. We assessed survival as a function of HbA(1c) in people with type 2 diabetes.Methods Two cohorts of patients aged 50 years and older with type 2 diabetes were generated from the UK General Practice Research Database from November 1986 to November 2008. We identified 27965 patients whose treatment had been intensified from oral monotherapy to combination therapy with oral blood-glucose lowering agents, and 20005 who had changed to regimens that included insulin. Those with diabetes secondary to other causes were excluded. All-cause mortality was the primary outcome. Age, sex, smoking status, cholesterol, cardiovascular risk, and general morbidity were identified as important confounding factors, and Cox survival models were adjusted for these factors accordingly.Findings For combined cohorts, compared with the glycated haemoglobin (HbA(1c)) decile with the lowest hazard (median HbA(1c) 7.5%, IQR 7.5-7.6%), the adjusted hazard ratio (HR) of all-cause mortality in the lowest HbA(1c) decile (6.4%, 6.1-6.6) was 1.52 (95% Cl 1.32-1.76), and in the highest HbA(1c) decile (median 10.5%, IQR 10.1-11.2%) was 1.79 (95% Cl 1.56-2.06). Results showed a general U-shaped association, with the lowest HR at an HbA(1c) of about 7.5%. HR for all-cause mortality in people given insulin-based regimens (2834 deaths) versus those given combination oral agents (2035) was 1.49 (95% Cl 1.39-1.59).Interpretation Low and high mean HbA(1c) values were associated with increased all-cause mortality and cardiac events. If confirmed, diabetes guidelines might need revision to include a minimum HbA(1c) value.