Can Hou, Huazhen Yang, Yuanyuan Qu, Wenwen Chen, Yu Zeng, Yao Hu, K M Venkat Narayan, Huan Song, Dong Li
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引用次数: 1
摘要
背景:尽管越来越多的证据表明，早发型2型糖尿病(T2DM)使患者更容易出现血管以外的并发症，但目前缺乏对所有相关系统并发症模式的全面分析。方法:我们前瞻性地研究了1777例早发性(诊断时年龄≤45岁)和35889例晚发性(>45岁)T2DM患者与来自UK Biobank的匹配的未暴露个体。使用全现象关联分析检查糖尿病特异性和相关并发症，并通过合并症网络分析确定模式。我们还评估了生活方式改变和血糖控制对并发症发展的影响。结果:早发性和晚发性T2DM患者的中位随访时间分别为17.83年和9.39年。与迟发性T2DM患者相比，早发性T2DM患者发生主要影响感觉器官、内分泌/代谢系统(HR 3.08 vs. 2.01)和神经系统(HR 2.70 vs. 1.81)的后续并发症的相对风险明显更高。尽管合并症模式有很大的相似之处，但在早发型T2DM中观察到一个更复杂且连接良好的网络。此外，虽然与迟发性T2DM患者相比，早发性T2DM患者通过合理控制血糖(中位HbA1c≤53 mmol/mol)获得的益处(所有研究并发症的总HR降低12.67%)较少(降低18.01%)，但他们似乎从良好的生活方式中获益更多，包括体重控制、健康饮食和充足的体育活动。结论:我们的分析表明，早发性T2DM是一种侵袭性疾病，其并发症网络比晚发性T2DM更复杂。积极的降糖干预，辅以生活方式的改变，是控制早发性t2dm相关并发症的可行策略。
Health consequences of early-onset compared with late-onset type 2 diabetes mellitus.
Background: Although cumulating evidence has suggested that early-onset type 2 diabetes mellitus (T2DM) conferred on patients a broader tendency for complications beyond vascular ones, a comprehensive analysis of patterns of complications across all relevant systems is currently lacking.
Method: We prospectively studied 1 777 early-onset (age at diagnosis ≤ 45 years) and 35 889 late-onset (>45 years) T2DM patients with matched unexposed individuals from the UK Biobank. Diabetes-specific and -related complications were examined using phenome-wide association analysis, with patterns identified by comorbidity network analysis. We also evaluated the effect of lifestyle modifications and glycemic control on complication development.
Results: The median follow-up times for early-onset and late-onset T2DM patients were 17.83 and 9.39 years, respectively. Compared to late-onset T2DM patients, patients with early-onset T2DM faced a significantly higher relative risk of developing subsequent complications that primarily affected sense organs [hazard ratio (HR) 3.46 vs. 1.72], the endocrine/metabolic system (HR 3.08 vs. 2.01), and the neurological system (HR 2.70 vs. 1.81). Despite large similarities in comorbidity patterns, a more complex and well-connected network was observed for early-onset T2DM. Furthermore, while patients with early-onset T2DM got fewer benefits (12.67% reduction in pooled HR for all studied complications) through fair glycemic control (median HbA1c ≤ 53 mmol/mol) compared to late-onset T2DM patients (18.01% reduction), they seemed to benefit more from favorable lifestyles, including weight control, healthy diet, and adequate physical activity.
Conclusions: Our analyses reveal that early-onset T2DM is an aggressive disease resulting in more complex complication networks than late-onset T2DM. Aggressive glucose-lowering intervention, complemented by lifestyle modifications, are feasible strategies for controlling early-onset T2DM-related complications.
期刊介绍：
Precision Clinical Medicine (PCM) is an international, peer-reviewed, open access journal that provides timely publication of original research articles, case reports, reviews, editorials, and perspectives across the spectrum of precision medicine. The journal's mission is to deliver new theories, methods, and evidence that enhance disease diagnosis, treatment, prevention, and prognosis, thereby establishing a vital communication platform for clinicians and researchers that has the potential to transform medical practice. PCM encompasses all facets of precision medicine, which involves personalized approaches to diagnosis, treatment, and prevention, tailored to individual patients or patient subgroups based on their unique genetic, phenotypic, or psychosocial profiles. The clinical conditions addressed by the journal include a wide range of areas such as cancer, infectious diseases, inherited diseases, complex diseases, and rare diseases.
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