空腹血糖长期变异性与2型糖尿病患者死亡风险的前瞻性队列研究

陈一佳; 覃玉; 俞浩; 朱政; 沈冲; 陆艳; 程亭亭; 张宁; 顾淑君; 周金意; 武鸣; 苏健

Abstract

陈一佳,覃玉,俞浩,朱政,沈冲,陆艳,程亭亭,张宁,顾淑君,周金意,武鸣,苏健.空腹血糖长期变异性与2型糖尿病患者死亡风险的前瞻性队列研究[J].Chinese journal of Epidemiology,2023,44(7):1099-1105

空腹血糖长期变异性与2型糖尿病患者死亡风险的前瞻性队列研究

A prospective cohort study of long-term fasting blood glucose variability and risk of mortality in patients with type 2 diabetes

Received:December 26, 2022

DOI：10.3760/cma.j.cn112338-20221226-01084

KeyWord: 糖尿病，2型空腹血糖变异性死亡风险前瞻性研究

English Key Word: Diabetes mellitus, type 2 Fasting blood glucose variability Mortality Prospective study

FundProject:江苏省卫生健康委员会2020年医学研究项目（M2020085）；江苏省领军人才与创新团队项目（K201105）；江苏省第五届“333工程”科研项目（BRA2020090）；苏州市科技计划（SS202010）

Author Name	Affiliation	E-mail
Chen Yijia	Department of Non-communicable Chronic Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China
Qin Yu	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Yu Hao	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Zhu Zheng	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Shen Chong	Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
Lu Yan	Department of Non-communicable Chronic Disease Prevention, Suzhou Prefectural Center for Disease Control and Prevention, Suzhou 215004, China
Cheng Tingting	Department of Infectious Disease Control Division, Suzhou National New & Hi-Tech Industrial Development Zone (Huqiu District) Center for Disease Control and Prevention, Suzhou 215163, China
Zhang Ning	Changshu County Center for Disease Control and Prevention, Changshu 215500, China
Gu Shujun	Department of Non-communicable Chronic Disease Prevention, Changshu County Center for Disease Control and Prevention, Changshu 215500, China
Zhou Jinyi	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Wu Ming	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Su Jian	Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China	sujiangx@163.com

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Abstract:

目的探讨空腹血糖（FPG）长期变异性与2型糖尿病（T2DM）患者全因死亡风险的关联。方法以江苏省常熟市纳入国家基本公共卫生服务管理的7 174名T2DM患者作为观察队列。基于≥3次随访的FPG值，计算并使用其标准差（SD）、变异系数（CV）、平均真实变异（ARV）和独立于均值的变异系数（VIM）评价长期FPG变异性。死亡信息主要通过江苏省居民死因监测系统获取。利用Cox比例风险回归模型分析4个变异性指标与T2DM患者全因死亡风险比（HR）及其95%CI。结果截至2021年12月31日，研究人群累计随访55 058.50人年，平均随访7.67年，随访期间发生死亡898名。在调整混杂因素后，Cox比例风险回归分析显示，与T₁组相比，SD、CV、ARV和VIM的T₃组发生全因死亡的HR值（95%CI）分别为1.24（1.03~1.49）、1.20（1.01~1.43）、1.28（1.07~1.55）和1.20（1.01~1.41）。SD、CV、ARV和VIM每增加1个单位SD，T2DM患者发生全因死亡的HR值（95%CI）分别为1.13（1.06~1.21）、1.08（1.01~1.15）、1.05（1.00~1.12）和1.09（1.02~1.16）。分层分析中年龄、性别、降糖药物和胰岛素使用对上述关联无影响（交互作用均P>0.05）。结论 FPG长期变异性与T2DM患者全因死亡风险呈正相关。

English Abstract:

Objective To investigate the association between long-term fasting blood glucose (FPG) variability and all-cause mortality in patients with type 2 diabetes. Methods A total of 7 174 type 2 diabetic patients included in National Basic Public Health Service Program in Changshu of Jiangsu Province were recruited as participants. Long-term glucose variability was assessed using standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of the mean (VIM) across FPG measurements at the more than three visits. Death information were mainly obtained from the death registry system in Jiangsu. Then Cox proportional hazards regression models were used to estimate the associations of four variability indicators and all-cause mortality's hazard ratios (HRs) and their 95%CIs. Results Among 55 058.50 person-years of the follow-up, the mean follow-up time was 7.67 years, and 898 deaths occurred during the follow-up period. After adjustment, compared with T₁ group, the Cox regression model showed that HRs of T₃ group in SD, CV, ARV and VIM were 1.24 (95%CI:1.03-1.49), 1.20 (95%CI:1.01-1.43), 1.28 (95%CI:1.07-1.55) and 1.20 (95%CI:1.01-1.41), respectively. HRs of per 1 SD higher SD, CV, ARV and VIM were 1.13 (95%CI:1.06-1.21), 1.08 (95%CI:1.01-1.15), 1.05 (95%CI:1.00-1.12) and 1.09 (95%CI:1.02-1.16) for all-cause mortality, respectively. In the stratified analysis, age, gender, hypoglycemic agent and insulin uses had no effect on the above associations (all P for interaction >0.05). Conclusion Long-term FPG glycemic variability was positively associated with the risk of all-cause mortality in type 2 diabetes patients.

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