Yingchai Zhang, Hongjiang Wu, Aimin Yang, Noel Y.H. Ng, Xinge Zhang, Eric S. H. Lau, Edith W. K. Chow, Alice P. S. Kong, Elaine Y. K. Chow, Juliana C. N. Chan, Andrea O. Y. Luk, Ronald C. W. Ma
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We used Cox regression models to compare the risk of incident diabetes in individuals with and without PHPT, and the risk of incident diabetes in PHPT patients with serum calcium concentration above and below the median value. The association between serum calcium concentrations and the risk of incident diabetes was examined by restricted cubic spline analyses in patients with PHPT.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>During a median follow-up time of 5.17 years (IQR 2.17, 9.58), 433 patients (15.75%) with PHPT and 2110 individuals (15.35%) without PHPT developed diabetes, respectively. Patients with PHPT had a higher incidence rate of diabetes compared to non-PHPT individuals (27.60 [95% CI 25.00, 30.30] vs. 23.90 [95% CI 22.80, 24.90] per 1000 person-years, log-rank test <i>p</i> = .007]. Crude Cox regression model showed PHPT was associated with a 15% higher risk of incident diabetes (HR 1.15, 95%CI 1.04, 1.28). In patients with PHPT, a 44% higher risk of incident diabetes was found in patients with serum calcium concentrations above the median value (2.63 mmol/L), compared to those below the median value (HR 1.44, 95%CI 1.08, 1.90). Restricted cubic spline analyses confirmed a positive linear association between serum calcium concentrations and the risk of incident diabetes in those with PHPT (<i>p</i>-value for nonlinear = .751)</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Patients with PHPT had a higher risk of incident diabetes compared to non-PHPT individuals. 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引用次数: 0
摘要
研究目的在大型人群纵向研究中，有关原发性甲状旁腺功能亢进症（PHPT）与糖尿病发病之间关系的数据相对较少。我们旨在评估原发性甲状旁腺功能亢进症患者和非原发性甲状旁腺功能亢进症患者罹患糖尿病的风险，并调查血清钙浓度与原发性甲状旁腺功能亢进症患者罹患糖尿病风险之间的关系：我们纳入了 2000-2019 年间的 2749 名 PHPT 患者和 13745 名年龄、性别和指数年相匹配的非 PHPT 患者。我们使用Cox回归模型比较了PHPT患者和非PHPT患者的糖尿病发病风险，以及血清钙浓度高于和低于中位值的PHPT患者的糖尿病发病风险。通过对PHPT患者进行限制性三次样条分析，研究了血清钙浓度与糖尿病发病风险之间的关系：在中位 5.17 年（IQR 2.17，9.58）的随访时间内，分别有 433 名 PHPT 患者（15.75%）和 2110 名非 PHPT 患者（15.35%）罹患糖尿病。与非PHPT患者相比，PHPT患者的糖尿病发病率更高（27.60 [95% CI 25.00, 30.30] vs. 23.90 [95% CI 22.80, 24.90] per 1000 person-years，log-rank检验 p = .007）。粗略的考克斯回归模型显示，PHPT 与糖尿病发病风险增加 15% 相关（HR 1.15，95%CI 1.04，1.28）。在 PHPT 患者中，血清钙浓度高于中位值（2.63 mmol/L）的患者与低于中位值的患者相比，发生糖尿病的风险高出 44%（HR 1.44，95%CI 1.08，1.90）。限制性三次样条分析证实，PHPT 患者的血清钙浓度与糖尿病发病风险呈正线性关系（非线性的 p 值 = .751）：与非PHPT患者相比，PHPT患者罹患糖尿病的风险更高。研究发现，PHPT 患者的血清钙浓度与糖尿病发病风险呈正线性关系。
Higher risk of incident diabetes among patients with primary hyperparathyroidism
Objectives
There is relatively scarce data regarding the association between primary hyperparathyroidism (PHPT) and incident diabetes in large population-based longitudinal studies. We aimed to evaluate the risk of incident diabetes in individuals with and without PHPT and investigate the association between serum calcium concentrations and the risk of incident diabetes in patients with PHPT.
Methods
We included 2749 PHPT patients and 13,745 age, sex and index year matched non-PHPT individuals during 2000–2019. We used Cox regression models to compare the risk of incident diabetes in individuals with and without PHPT, and the risk of incident diabetes in PHPT patients with serum calcium concentration above and below the median value. The association between serum calcium concentrations and the risk of incident diabetes was examined by restricted cubic spline analyses in patients with PHPT.
Results
During a median follow-up time of 5.17 years (IQR 2.17, 9.58), 433 patients (15.75%) with PHPT and 2110 individuals (15.35%) without PHPT developed diabetes, respectively. Patients with PHPT had a higher incidence rate of diabetes compared to non-PHPT individuals (27.60 [95% CI 25.00, 30.30] vs. 23.90 [95% CI 22.80, 24.90] per 1000 person-years, log-rank test p = .007]. Crude Cox regression model showed PHPT was associated with a 15% higher risk of incident diabetes (HR 1.15, 95%CI 1.04, 1.28). In patients with PHPT, a 44% higher risk of incident diabetes was found in patients with serum calcium concentrations above the median value (2.63 mmol/L), compared to those below the median value (HR 1.44, 95%CI 1.08, 1.90). Restricted cubic spline analyses confirmed a positive linear association between serum calcium concentrations and the risk of incident diabetes in those with PHPT (p-value for nonlinear = .751)
Conclusions
Patients with PHPT had a higher risk of incident diabetes compared to non-PHPT individuals. A positive linear association was found between serum calcium concentrations and the risk of incident diabetes in patients with PHPT.
期刊介绍：
Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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