较年轻发病与较晚发病的 2 型糖尿病：英国前瞻性糖尿病研究（UKPDS）长达 30 年的随访分析（UKPDS 92）

IF 44 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

The Lancet Diabetes & Endocrinology Pub Date : 2024-10-23 DOI:10.1016/s2213-8587(24)00242-0

Beryl Lin, Ruth L Coleman, Fiona Bragg, Ernesto Maddaloni, Rury R Holman, Amanda I Adler

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引用次数: 0

摘要

背景年轻的 2 型糖尿病患者会加速并发症的发生。我们评估了在 30 年的随访过程中，年轻患者的并发症发生率和死亡率与老年患者相比是否存在差异。方法在这项研究中，我们使用了 1977 年至 2007 年间收集的英国 2 型糖尿病研究数据，这些数据针对的是 25-65 岁新诊断出的 2 型糖尿病患者，他们发病年龄较小（小于 40 岁）或发病较晚（40 岁或以上），且无糖尿病自身抗体。我们利用英国普通人群数据分析了标准化死亡率（SMR），并按诊断时的 10 年年龄间隔分析了预设结果的发病率。2704人（59-4%）为男性，平均HbA1c为76 mmol/mol（SD 24-6）。随访中位数为 17-5 年（IQR 12-7-20-8）。较年轻发病的 2 型糖尿病的 SMR（3-72 [95% CI 2-98-4-64]）高于较晚发病的 2 型糖尿病（1-54 [1-47-1-61]）。除微血管疾病（年轻发病者为每 1000 人-年 14-5 (11-9-17-7) vs 较晚发病者为每 1000 人-年 12-1 (11-3-13-0)）外，较晚发病的 2 型糖尿病患者所有结果的发病率都较高。然而，在任何特定年龄段，糖尿病相关终点、全因死亡率、微血管疾病和心肌梗死的 5 年发病率都是发病年龄越小越高。与晚期发病的2型糖尿病患者相比，年轻患者在最初20年的年平均HbA1c值更高。在随机接受强化血糖控制与常规血糖控制的参与者中，我们没有观察到发病年龄较小与发病时间较晚的 2 型糖尿病亚组在任何结果上的相互作用。年轻2型糖尿病患者的并发症风险增加，血糖控制较差，因此需要开发相关服务来识别和管理这些患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up (UKPDS 92)

Background

Younger-onset type 2 diabetes is associated with accelerated complications. We assessed whether complications and mortality rates differed for younger age compared with older age at diagnosis over 30 years of follow-up.

Methods

In this study, we used data from the UKPDS, collected between 1977 and 2007, of participants aged 25–65 years with newly diagnosed type 2 diabetes with younger-onset (younger than 40 years) or later-onset (40 years or older), and without diabetes autoantibodies. We analysed standardised mortality ratios (SMR) using UK general population data, and incidence rates of prespecified outcomes by 10-year age intervals at diagnosis.

Findings

Of 4550 participants testing negative to all measured autoantibodies, 429 (9·4%) had younger-onset type 2 diabetes. 2704 (59·4%) were male, and mean HbA_1c was 76 mmol/mol (SD 24·6). The median follow-up was 17·5 years (IQR 12·7–20·8). SMR for younger-onset type 2 diabetes was higher (3·72 [95% CI 2·98–4·64]) compared with later-onset type 2 diabetes (1·54 [1·47–1·61]). The incidence rate was higher for all outcomes in later-onset type 2 diabetes, except for microvascular disease (younger-onset 14·5 (11·9–17·7) vs later-onset 12·1 (11·3–13·0) per 1000 person-years). However, at any given age, the 5-year incidence of any diabetes-related endpoint, all-cause mortality, microvascular disease, and myocardial infarction was higher with younger age at diagnosis. Annual mean HbA_1c was higher in the first 20 years in younger-onset compared with later-onset type 2 diabetes. Among participants randomised to intensive versus conventional glycaemic control, we observed no interactions by subgroup of younger-onset versus later-onset type 2 diabetes for any outcome.

Interpretation

The risk of dying relative to the general population is even greater for people diagnosed with type 2 diabetes at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes calls for the development of services to identify and manage these individuals.

Funding

National Institute of Health and Care Research's Biomedical Research Centre.

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来源期刊

The Lancet Diabetes & Endocrinology ENDOCRINOLOGY & METABOLISM-

CiteScore

61.50

自引率

1.60%

发文量

371

期刊介绍： The Lancet Diabetes & Endocrinology, an independent journal with a global perspective and strong clinical focus, features original clinical research, expert reviews, news, and opinion pieces in each monthly issue. Covering topics like diabetes, obesity, nutrition, and more, the journal provides insights into clinical advances and practice-changing research worldwide. It welcomes original research advocating change or shedding light on clinical practice, as well as informative reviews on related topics, especially those with global health importance and relevance to low-income and middle-income countries. The journal publishes various content types, including Articles, Reviews, Comments, Correspondence, Health Policy, and Personal Views, along with Series and Commissions aiming to drive positive change in clinical practice and health policy in diabetes and endocrinology.