空腹血糖变异与2型糖尿病患者全死因死亡风险的关系

Relationship between plasma blood glucose variation and death risk from all death causes in type 2 diabetic mellitus patients

目的研究空腹血糖变异与2型糖尿病患者全死因死亡风险的关系,为2型糖尿病患者的血糖控制提供依据。方法从上海市闵行区居民电子健康档案系统(EHRs)中获取2007年1-12月建立2型糖尿病档案的患者资料,包括空腹血糖、血压、体质指数(BMI)、家族史和药物情况等。采用Cox比例风险回归模型分析血糖变异对糖尿病患者全因死亡风险的影响。结果共获得研究对象6 847例,818例(11.94%)患者在平均随访6.2年后死亡,死亡率为19.43/1 000人年。研究对象的空腹血糖标准差(FPG-SD)中位数为0.66 mmol/L,四分位数分别为S1(<0.37 mmol/L)、S2(0.37 mmol/L≤S2<0.66 mmol/L)、S3(0.66 mmol/L≤S3≤1.15 mmol/L)和S4(>1.15 mmol/L)。历次空腹血糖间的变异系数(FPG-CV)中位数为0.10,四分位数间距分别为C1(<0.06)、C2(0.06≤C2<0.10)、C3(0.10≤C3≤0.15)和C4(>0.15)。研究对象全死因死亡风险的影响指标包括年龄、收缩压、胰岛素、BMI、FPG-SD(S4)和FPG-CV(C4)(P<0.05)。结论空腹血糖的变异度是2型糖尿病患者全因死亡率的独立预测指标,在2型糖尿病治疗管理中不仅仅要关注血糖水平,更要关注血糖波动所带来的危害,做到平稳降糖、安全降糖。

Objective To study the relationship between fasting blood glucose variation and death risk from all death causes in type2 diabetic mellitus（T2DM） patients, and to provide the basis for controlling the blood glucose in T2 DM patients. Methods the data of T2 DM patients from January to December of 2007 were obtained from the electronic health record system（EHRs） of residents in Minhang District of Shanghai, which included the fasting blood glucose, blood pressure, body mass index（BMI）,family history, drug situation and so on. Cox proportional hazard regression model was used to analyze the influence of fasting blood glucose variation on death risk from all death causes in T2 DM patients. Results All subjects were 6 387 cases, 818 cases（11.94%） died in mean 6.2 years after follow up, the mortality was 19.43/1000 person-year. The median and interquartile ranges of fasting blood glucose stander（FPG-SD） in subjects were 0.66 mmol/L, 〈0.37 mmol/L（S1）, 0.37 mmol/L≤S2〈0.66 mmol/L,0.66 mmol/L≤S3≤1.15 mmol/L and 〉1.15 mmol/L（S4）, respectively. The median of coefficient of variation between fasting blood glucose（FPG-CV） was 0.10, and the interquartile ranges of FPG-CV were C1（〈0.06）, 0.06≤C2〈0.10, 0.10≤C3≤0.15 and C4（〉0.15）, respectively. The influencing factors for death risk from all death causes in the subjects were age, systolic pressure, insulin, FPG-SD（S4） and FPG-CV（C4）, P〈0.05. Conclusion The fasting blood glucose variety is the independent prediction indicator for all death causes mortality in T2 DM patients. We should not only pay attention to the blood glucose level,but also pay attention to the harm caused by the variability of blood glucose in T2 DM management.