Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study
Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study
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DOI：
10.1136/bmj.321.7258.405
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发表时间：
2000-08-12
影响因子：
105.7
通讯作者：
Holman, RR
中科院分区：
文献类型：
--
作者：
Stratton, IM;Adler, AI;Holman, RR
目的确定2型糖尿病患者随时间暴露于高血糖与大血管或微血管并发症风险之间的关系，设计前瞻性观察性研究，研究对象为英格兰、苏格兰和北方爱尔兰的23家医院诊所，参与者为4585名白色、亚洲印第安人和非洲加勒比人UKPDS患者，无论是否随机接受治疗，均纳入发病率分析;其中3642例被纳入相对危险度分析。结果测量主要预定义的总体临床结果：任何终点或与糖尿病相关的死亡和全因死亡。次要汇总结局：心肌梗塞、中风、截肢（包括外周血管疾病引起的死亡）和微血管疾病（主要是视网膜光凝）。单一终点：非致死性心力衰竭和白内障摘除术。风险降低与更新的平均HbA（1c）降低1%相关，调整了diabetes.Results诊断时可能的混杂因素，临床并发症的发生率与糖尿病显著相关。更新的平均HbA（1c）每降低1%，与糖尿病相关的任何终点的风险降低21（95%置信区间17%至24%，P < 0.0001），糖尿病相关死亡率为21%（15%~ 27%，P < 0.0001），心肌梗死为14%（8%~ 21%，P< 0.0001），微血管并发症为37%（33%~ 41%，P < 0.0001）。结论在2型糖尿病患者中，糖尿病并发症的风险与既往高血糖密切相关。HbA（1c）的任何降低都可能降低并发症的风险，其中HbA（1c）值在正常范围内（< 6.0%）的风险最低。
Objective To determine the relation between exposure to glycaemia over time and the risk of macro vascular or microvascular complications in patients with type 2 diabetes.Design Prospective observational study.Setting 23 hospital based clinics in England, Scotland, and Northern ireland.Participants 4585 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk.Outcome measures Primary predefined aggregate clinical outcomes: any end point or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 1% reduction in updated mean HbA(1c) adjusted for possible confounders at diagnosis of diabetes.Results The incidence of clinical complications was significantly associated with glycaemia. Each 1% reduction in updated mean HbA(1c) was associated with reductions in risk of 21% for any end point related to diabetes (95% confidence interval 17% to 24%, P < 0.0001), 21% for deaths related to diabetes (15% to 27%, P < 0.0001), 14% for myocardial infarction (8% to 21%, P< 0.0001), and 37% for microvascular complications (33% to 41%, P < 0.0001). No threshold of risk was observed for any end pointConclusions Ln patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia. Any reduction in HbA(1c) is likely to reduce the risk of complications, with the lowest risk being in those with HbA(1c) values in the normal range (< 6.0%).