Progression of coronary artery calcification in type 1 diabetes - The importance of glycemic control
Progression of coronary artery calcification in type 1 diabetes - The importance of glycemic control
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DOI：
10.2337/diacare.26.10.2923
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发表时间：
2003-10-01
期刊：
影响因子：
16.2
通讯作者：
Rewers, M
中科院分区：
文献类型：
--
作者：
Snell-Bergeon, JK;Hokanson, JK;Rewers, M
目的——冠状动脉疾病 (CAD) 发生在生命早期，并且对于 I 型糖尿病患者来说通常更致命。这种额外的风险似乎高于 2 型糖尿病患者，并且很难用传统的风险因素来解释。血糖控制的作用存在争议，之前尚未使用可靠的亚临床 CAD 标志物进行前瞻性讨论，例如通过电子束计算机断层扫描 (EBCT) 测量的冠状动脉钙化 (CAC)。 研究设计和方法 - 我们在 109 名患有 1 型糖尿病的男性和女性（年龄 22-50 岁）中，在 2.7 年的时间间隔内测量了两次 CAC。根据平方根转换的体积评分的变化，在 21 名患者中发现了 CAC 进展。 结果 - 在多重 Logistic 回归中，CAC 进展与基线高血糖相关（比值比 [OR] 7.11，95% CI 1.38-36.6，P = 0.02），根据基线时 CAC 的存在 (P = 0.01)、糖尿病持续时间 (P = 0.02), 性别 （P = 0.09）和年龄（P = 0.27）。较高的胰岛素剂量和较高的 BMI 也存在显着的交互作用 (P = 0.03)。 结论 - 总之，在这个年轻的 I 型糖尿病队列中，血糖控制不佳 (HbA(1c) >7.5%) 是 CAC 进展的一个强烈危险因素。胰岛素抵抗也可能发挥作用。
OBJECTIVE-Coronary artery disease (CAD) occurs earlier in life and is more often fatal in people with type I diabetes. This excess risk seems to be higher than in those with type 2 diabetes and is poorly explained by conventional risk factors. The role of glycemic control is controversial and has not been previously addressed in a prospective manner using a reliable marker for subclinical CAD, such as coronary artery calcification (CAC), measured by electron beam computed tomography (EBCT).RESEARCH DESIGN AND METHODS-We measured CAC twice during an interval of 2.7 years in 109 men and women with type 1 diabetes (aged 22-50 years). Progression of CAC was found in 21 patients, based on change in the square root-transformed volume score.RESULTS-In multiple logistic regression, CAC progression was associated with baseline hyperglycemia (odds ratio [OR] 7.11, 95% CI 1.38-36.6, P = 0.02), adjusted for the presence of CAC at baseline (P = 0.01), duration of diabetes (P = 0.02), sex (P = 0.09), and age (P = 0.27). There was also a significant interactive effect of higher insulin dose and higher BMI (P = 0.03).CONCLUSIONS-In conclusion, in this young cohort with type I diabetes, suboptimal glycemic control (HbA(1c) >7.5%) was a strong risk factor for progression of CAC. Insulin resistance may also play a role.