Regression to the Mean Contributes to the Apparent Improvement in Glycemia 3.8 Years After Screening: The ELSA-Brasil Study.
Regression to the Mean Contributes to the Apparent Improvement in Glycemia 3.8 Years After Screening: The ELSA-Brasil Study.
复制标题
DOI：
10.2337/dc20-2030
复制
发表时间：
2021-01
期刊：
影响因子：
16.2
通讯作者：
Duncan BB
中科院分区：
文献类型：
--
作者：
Schmidt MI;Bracco P;Canhada S;Guimarães JMN;Barreto SM;Chor D;Griep R;Yudkin JS;Duncan BB
糖基化回归在现实世界中很常见，但回归对平均值的贡献（RTM）却很少被研究。我们的目的是估计在一个新确诊的糖尿病和中度高血糖（IH）成人自由生活队列中调整RTM前后的血糖回归。巴西成人健康纵向研究（ELSA-Brasil）是一项队列研究，在2008年至2010年期间对15，105名成年人进行标准化口服葡萄糖耐量试验和HbA 1c筛查，在3.84 ± 0.42年后重复。在排除那些接受糖尿病药物治疗的患者后，我们计算了调整RTM基线值前后的部分或完全回归。对于新确诊的糖尿病，49.4%（95% CI 45.2-53.7）的患者部分或完全消退;校正RTM后，20.2%（95% CI 12.1-28.3）的患者部分或完全消退。关于IH，39.5%的患者恢复至正常水平（95% CI 37.9-41.3）或23.7%（95% CI 22.6-24.3），分别取决于使用世界卫生组织（WHO）或美国糖尿病协会（ADA）定义;校正后相应频率分别为26.1%（95%CI 22.4-28.1）和19.4%（95%CI 18.4-20.5）。调整RTM后，筛查时检出的病例数减少：糖尿病病例526例至94例，WHO定义的IH病例3，118例至1，986例，ADA定义的IH病例6，182例至5，711例。体重减轻≥2.6%与糖尿病（相对风险1.52，95% CI 1.26-1.84）和IH（相对风险1.30，95% CI 1.17-1.45）的更大消退相关。在这个准现实世界的环境中，14岁时糖尿病的消退是常见的，IH则较少。回归通常由RTM解释，但在一定程度上也与随访期间体重减轻和体内平衡改善有关。
Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA1c, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2–53.7); after adjustment for RTM, in 20.2% (95% CI 12.1–28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9–41.3) or in 23.7% (95% CI 22.6–24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4–28.1) and 19.4% (95% CI 18.4–20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26–1.84) and IH (relative risk 1.30, 95% CI 1.17–1.45). In this quasi–real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.
登录
查看更多内容
影响因子：
16.2
作者：
Karter AJ;Nundy S;Parker MM;Moffet HH;Huang ES
通讯作者：
Huang ES
DOI：
10.1016/s0140-6736(18)32225-6
发表时间：
2018-11-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2017 Risk Factor Collaborators
通讯作者：
GBD 2017 Risk Factor Collaborators
影响因子：
16.2
作者：
Esposito, Katherine;Maiorino, Maria Ida;Giugliano, Dario
通讯作者：
Giugliano, Dario
影响因子：
2.1
作者：
Rocconi, Louis M.;Ethington, Corinna A.
通讯作者：
Ethington, Corinna A.
影响因子：
2.8
作者：
Schmidt, Maria Ines;Griep, Rosane Haerter;Nunes, Maria Angelica
通讯作者：
Nunes, Maria Angelica