芬兰 1 型糖尿病患者的全因死亡率及其相关因素。

IF 2.9 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Journal of diabetes and its complications Pub Date : 2024-10-12 DOI:10.1016/j.jdiacomp.2024.108881

Elena Putula , Tuuli Kauppala , Sini Vanhamäki , Jaason Haapakoski , Tiina Laatikainen , Saara Metso

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引用次数: 0

摘要

目的：评估合并症、根据白蛋白尿和 eGFR 进行的慢性肾脏病（CKD）风险分类、HbA1c 和低密度脂蛋白胆固醇水平对 1 型糖尿病（DM1）患者全因死亡率的影响：研究纳入了2018-2022年间芬兰糖尿病登记处的所有45801名DM1患者。通过估算标准化死亡率（SMR），将DM1患者的死亡率与芬兰非糖尿病人群的死亡率进行比较。采用泊松回归模型估算风险因素对标准化死亡率的影响：结果：共有 2469 名患者在随访期间死亡。整个队列的标准化死亡率为 1.84 (95 % CI 1.77-1.92)，在 30-49 岁年龄段达到高峰。HbA1c 值的覆盖率为 98%，低密度脂蛋白胆固醇的覆盖率为 94%，U-ACR 和 eGFR 的覆盖率为 80%。在评估对死亡率影响的多变量分析中，终末期肾病的比率为 2.66，心血管疾病为 1.92，精神和行为障碍为 1.64，足部并发症为 1.51，慢性肾脏病高风险或极高风险为 3.64，低密度脂蛋白胆固醇≥2.6 mmol/l 为 1.33，HbA1c ≥8 %（64 mmol/mol）为 1.27：在芬兰，DM1导致的死亡率过高。干预措施应侧重于解决肾脏和心血管风险因素，同时也要更加关注心理健康。

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All-cause mortality and factors associated with it in Finnish patients with type 1 diabetes

Aims

To assess the effect of comorbidities, risk classification for chronic kidney disease (CKD) according to albuminuria and eGFR, HbA1c and LDL-cholesterol levels on all-cause mortality in patients with type 1 diabetes (DM1).

Methods

The study included all 45,801 DM1 patients from the Finnish Diabetes Registry during 2018–2022. Mortality of patients with DM1 was compared with mortality in non-diabetic population in Finland by estimating standardized mortality rates (SMRs). Poisson regression model was used to estimate the effect of risk factors on the SMR.

Results

A total of 2469 patients died during follow-up. SMR for the total cohort was 1.84 (95 % CI 1.77–1.92) peaking at the age of 30–49 years. The coverage of HbA1c values was 98 %, that of LDL-cholesterol 94 %, and U-ACR and eGFR 80 %. In a multivariate analysis, assessing the effect on mortality, the rate ratio for end-stage renal disease was 2.66, cardiovascular diseases 1.92, mental and behavioural disorders 1.64, foot complications 1.51, high or very high risk for CKD 3.64, LDL-cholesterol ≥2.6 mmol/l 1.33, and HbA1c ≥8 % (64 mmol/mol) 1.27.

Conclusions

There's substantial excess mortality due to DM1 in Finland. Interventions should focus on addressing both renal and cardiovascular risk factors but also pay more attention to mental health.

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来源期刊

Journal of diabetes and its complications 医学-内分泌学与代谢

CiteScore

5.90

自引率

3.30%

发文量

153

审稿时长

16 days

期刊介绍： Journal of Diabetes and Its Complications (JDC) is a journal for health care practitioners and researchers, that publishes original research about the pathogenesis, diagnosis and management of diabetes mellitus and its complications. JDC also publishes articles on physiological and molecular aspects of glucose homeostasis. The primary purpose of JDC is to act as a source of information usable by diabetes practitioners and researchers to increase their knowledge about mechanisms of diabetes and complications development, and promote better management of people with diabetes who are at risk for those complications. Manuscripts submitted to JDC can report any aspect of basic, translational or clinical research as well as epidemiology. Topics can range broadly from early prediabetes to late-stage complicated diabetes. Topics relevant to basic/translational reports include pancreatic islet dysfunction and insulin resistance, altered adipose tissue function in diabetes, altered neuronal control of glucose homeostasis and mechanisms of drug action. Topics relevant to diabetic complications include diabetic retinopathy, neuropathy and nephropathy; peripheral vascular disease and coronary heart disease; gastrointestinal disorders, renal failure and impotence; and hypertension and hyperlipidemia.