瑞典研究人员根据“瑞典国家糖尿病登记表”和“瑞典死因登记表”的数据进行了一项观察性研究,发现在糖化血红蛋白水平≤6.9%的1型糖尿病病人中,各种原因所致死亡和心血管因素所致死亡的风险,均高达与之匹配的对照组的2倍。

—2014年11月20日《新英格兰医学杂志》

中文译文



【题目】1型糖尿病中的血糖控制与过量死亡率
【译文】
背景:在血糖控制在不同水平的1型糖尿病病人中,由于各种原因和心血管因素所致死亡的过度风险仍然未知。我们进行了一项基于登记表的观察性研究,根据瑞典的糖尿病人群的血糖控制水平,来确定死亡的过度风险。
方法:我们的研究纳入了1998年1月1日之后在“瑞典国家糖尿病登记表”中登记的1型糖尿病病人。根据年龄、性别和籍贯,每个病人匹配5个对照,对照从普通人群中随机选取。通过“瑞典死因登记表”,病人和对照均随访到2011年12月31日。
结果:糖尿病病人和对照的平均年龄分别为35.8岁和35.7岁,各组中女性均占45.1%。病例组和对照组的平均随访时间分别为8.0年和8.3年。总体上,33,915个糖尿病病人中有2701人(8.0%)死亡,而对照组的169,249人中有4835人(2.9%)死亡(校正的危险比HR为3.52,95%可行区间[CI] 3.06-4.04);心血管因素所致死亡率分别为2.7%和0.9%(校正HR为4.60,95%CI 3.47-6.10)。根据糖尿病病人糖化血红蛋白水平,与对照组相比,多种因素校正后各种原因所致死亡的HR,在糖化血红蛋白为≤6.9%(≤52 mmol/mol)的病人中为2.36(95%CI 1.97-2.83),在糖化血红蛋白水平为7.0-7.8%(53-62 mmol/mol)的病人中为2.38(95%CI 2.02-2.80),在7.9-8.7%(63-72 mmol/mol)的病人中为3.11(95%CI 2.66-3.62),在8.8-9.6%(73-82 mmol/mol)的病人中为3.65(95%CI 3.11-4.30),在≥9.7%(≥83 mmol/mol)的病人中为8.51(95%CI 7.24-10.01)。相应的心血管因素所致死亡HR为2.91(95%CI 2.07-4.13),3.39(95%CI 2.49-4.61),4.44(95%CI 3.32-5.96),5.35(95%CI 3.94-7.26)和10.46(95%CI 7.62-14.37)。
结论:在我们的基于登记表的观察性研究中,在糖化血红蛋白水平≤6.9%的1型糖尿病病人中,各种原因所致死亡和心血管因素所致死亡的风险,均高达与之匹配的对照组的2倍。

 

英文原稿


 

[Title] Glycemic Control and Excess Mortality in Type 1 Diabetes.

[Authors] Marcus Lind, M.D., Ph.D., Ann-Marie Svensson, Ph.D., Mikhail Kosiborod, M.D., Soffia Gudbjörnsdottir, M.D., Ph.D., Aldina Pivodic, M.Sc., Hans Wedel, Ph.D., et al.
[Abstract]
BACKGROUND : The excess risk of death from any cause and of death from cardiovascular causes is unknown among patients with type 1 diabetes and various levels of glycemic control. We conducted a registry-based observational study to determine the excess risk of death according to the level of glycemic control in a Swedish population of patients with diabetes.
METHODS: We included in our study patients with type 1 diabetes registered in the Swedish National Diabetes Register after January 1, 1998. For each patient, five controls were randomly selected from the general population and matched according to age, sex, and county. Patients and controls were followed until December 31, 2011, through the Swedish Register for Cause-Specific Mortality.
RESULTS: The mean age of the patients with diabetes and the controls at baseline was 35.8 and 35.7 years, respectively, and 45.1% of the participants in each group were women. The mean follow-up in the diabetes and control groups was 8.0 and 8.3 years, respectively. Overall, 2701 of 33,915 patients with diabetes (8.0%) died, as compared with 4835 of 169,249 controls (2.9%) (adjusted hazard ratio, 3.52; 95% confidence interval [CI], 3.06 to 4.04); the corresponding rates of death from cardiovascular causes were 2.7% and 0.9% (adjusted hazard ratio, 4.60; 95% CI, 3.47 to 6.10). The multivariable-adjusted hazard ratios for death from any cause according to the glycated hemoglobin level for patients with diabetes as compared with controls were 2.36 (95% CI, 1.97 to 2.83) for a glycated hemoglobin level of 6.9% or lower (≤52 mmol per mole), 2.38 (95% CI, 2.02 to 2.80) for a level of 7.0 to 7.8% (53 to 62 mmol per mole), 3.11 (95% CI, 2.66 to 3.62) for a level of 7.9 to 8.7% (63 to 72 mmol per mole), 3.65 (95% CI, 3.11 to 4.30) for a level of 8.8 to 9.6% (73 to 82 mmol per mole), and 8.51 (95% CI, 7.24 to 10.01) for a level of 9.7% or higher (≥83 mmol per mole). Corresponding hazard ratios for death from cardiovascular causes were 2.92 (95% CI, 2.07 to 4.13), 3.39 (95% CI, 2.49 to 4.61), 4.44 (95% CI, 3.32 to 5.96), 5.35 (95% CI, 3.94 to 7.26), and 10.46 (95% CI, 7.62 to 14.37).
CONCLUSIONS: In our registry-based observational study, patients with type 1 diabetes and a glycated hemoglobin level of 6.9% or lower had a risk of death from any cause or from cardiovascular causes that was twice as high as the risk for matched controls.

原文网址:

http://www.nejm.org/doi/full/10.1056/NEJMoa1408214?query=featured_home

本站声明: 生物文库所有文章欢迎转载,所有文章未说明,均属于原创,转载均请注明出处。
本文链接: http://www.bioku.cn/201411/new-england-journal-of-medicine-2014-11-20/
版权所有: 生物文库 - 生物医学、生物技术核心期刊文摘

留言


× 2 = 二


沪ICP备12028140号
点击这里给我发消息   点击这里给我发消息