真实世界人群中确诊 2 型糖尿病前后的体重指数轨迹。

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetologia Pub Date : 2024-10-01 Epub Date: 2024-07-05 DOI:10.1007/s00125-024-06217-1
Louise A Donnelly, Rory J McCrimmon, Ewan R Pearson
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引用次数: 0

摘要

目的/假设:很少有研究对 2 型糖尿病确诊前后体重变化的相关临床特征进行研究。我们利用一个大型真实世界队列,得出了糖尿病诊断前后的体重指数轨迹,并研究了与这些轨迹相关的临床特征,包括评估诊断前体重变化对诊断后体重变化的影响:我们利用苏格兰护理信息糖尿病协作数据库中的个人电子病历进行了一项观察性队列研究。根据诊断前 3 年至 6 个月期间和诊断后 1 年至 5 年期间观察到的 BMI 测量值,计算出两种轨迹。在诊断后的轨迹中,每个 BMI 测量值都根据糖尿病药物和 HbA1c 变化的影响进行了时间调整:研究共纳入了 2736 人。诊断前体重增加的模式为:1944 人(71%)总体体重增加,875 人(32%)每年体重增加超过 0.5 kg/m2。随后是诊断后体重下降的模式,有 1722 人(63%)体重下降。年龄越小、社会贫困程度越高,确诊前体重增加越多。诊断前的体重变化与诊断后的体重变化无关,但诊断后体重减轻与年龄较大、性别为女性、体重指数(BMI)较高、HbA1c 较高以及诊断前体重增加有关。如果考虑到围诊断期(定义为诊断前 6 个月至诊断后 12 个月),我们发现有 986 人(36%)在诊断时 HbA1c 较高,但体重迅速下降,并在 1 年时接受了最积极的治疗;该亚群在 5 年时血糖控制得最好:平均体重在确诊前增加,确诊后减少;然而,不同人群的体重变化存在显著差异。年轻人在确诊前体重增加,但在老年人中,2 型糖尿病与体重增加的关系不大,这与老年人糖尿病病因的其他驱动因素一致。我们发现有相当一部分人在确诊时血糖控制迅速恶化,同时体重下降,但随后又趋于稳定,这表明确诊时的高 HbA1c 并不必然与不良预后有关,可能是由可逆的葡萄糖毒性引起的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Trajectories of BMI before and after diagnosis of type 2 diabetes in a real-world population.

Trajectories of BMI before and after diagnosis of type 2 diabetes in a real-world population.

Aims/hypothesis: Few studies have examined the clinical characteristics associated with changes in weight before and after diagnosis of type 2 diabetes. Using a large real-world cohort, we derived trajectories of BMI before and after diabetes diagnosis, and examined the clinical characteristics associated with these trajectories, including assessing the impact of pre-diagnosis weight change on post-diagnosis weight change.

Methods: We performed an observational cohort study using electronic medical records from individuals in the Scottish Care Information Diabetes Collaboration database. Two trajectories were calculated, based on observed BMI measurements between 3 years and 6 months before diagnosis and between 1 and 5 years after diagnosis. In the post-diagnosis trajectory, each BMI measurement was time-dependently adjusted for the effects of diabetes medications and HbA1c change.

Results: A total of 2736 individuals were included in the study. There was a pattern of pre-diagnosis weight gain, with 1944 individuals (71%) gaining weight overall, and 875 (32%) gaining more than 0.5 kg/m2 per year. This was followed by a pattern of weight loss after diagnosis, with 1722 individuals (63%) losing weight. Younger age and greater social deprivation were associated with increased weight gain before diagnosis. Pre-diagnosis weight change was unrelated to post-diagnosis weight change, but post-diagnosis weight loss was associated with older age, female sex, higher BMI, higher HbA1c and weight gain during the peri-diagnosis period. When considering the peri-diagnostic period (defined as from 6 months before to 12 months after diagnosis), we identified 986 (36%) individuals who had a high HbA1c at diagnosis but who lost weight rapidly and were most aggressively treated at 1 year; this subgroup had the best glycaemic control at 5 years.

Conclusions/interpretation: Average weight increases before diagnosis and decreases after diagnosis; however, there were significant differences across the population in terms of weight changes. Younger individuals gained weight pre-diagnosis, but, in older individuals, type 2 diabetes is less associated with weight gain, consistent with other drivers for diabetes aetiology in older adults. We have identified a substantial group of individuals who have a rapid deterioration in glycaemic control, together with weight loss, around the time of diagnosis, and who subsequently stabilise, suggesting that a high HbA1c at diagnosis is not inevitably associated with a poor outcome and may be driven by reversible glucose toxicity.

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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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