住院早发2型糖尿病患者代谢特征及慢性并发症情况

Metabolic profile and chronic complications in hospitalized patients with early onset type 2 diabetes mellitus

目的分析早发2型糖尿病(T2DM)患者代谢指标及糖尿病慢性并发症特点,并进一步探讨初发的早发T2DM患者代谢指标转归。方法回顾性收集南京鼓楼医院内分泌科2015年1月至2018年9月3 628例T2DM住院患者的临床资料,根据发病年龄分为早发组(<40岁,n=768)和晚发组(≥40岁,n=2 860)。早发组平均年龄(41±11)岁,其中男性546例(71.1%),晚发组平均年龄(63±10)岁,其中男性1 690例(59.1%)。采集病史及体格检查数据,包括病程、体质指数、糖尿病家族史等。并检测空腹血糖(FPG)、糖化血红蛋白等指标。采用独立样本t检验、χ^2检验、Mann-WhitneyU检验比较两组的临床资料,利用相加交互作用模型分析早发T2DM与病程的交互作用,建立多因素logistic回归模型分析影响早发T2DM患者并发症发生的相关因素。针对初发的T2DM患者(病程<1年),比较早发及晚发组代谢指标转归情况。结果相比于晚发组,早发组有糖尿病家族史的比例更高,体质指数更大(均P<0.01)。早发组糖化血红蛋白更高(9.2%±2.1%比8.7%±2.2%,t=-4.454,P<0.01),糖尿病微血管并发症(糖尿病肾脏疾病、糖尿病视网膜病变)比例更高 [38.8%(298/768)比29.4%(841/2 860),χ^2=24.819,P<0.01]。微血管并发症方面,早发T2DM与病程≥10年存在交互作用。校正年龄、病程、糖尿病家族史、传统心血管危险因素及治疗方案等因素,早发组合并糖尿病肾脏疾病风险仍高于晚发组(比值比1.66,95%可信区间:1.01~2.71,P<0.05)。对于初发的T2DM患者,中位随访时间373 d,早发组较晚发组FPG下降更明显(ΔFPG早发组-ΔFPG晚发组=-0.62 mmol/L,95%可信区间:-1.18 mmol/L,-0.05 mmol/L)。结论早发T2DM患者代谢指标控制更差,合并糖尿病并发症风险更高,应重视早发T2DM的早期干预。

Objective To study the features of metabolic profile and chronic complications in early-onset type 2 diabetes mellitus(T2DM)patients and further investigate their prognosis.Methods Clinical data of diabetes patients(n=3628)admitted to the Department of Endocrinology Nanjing Drum Tower Hospital from January 2015 to September 2018 were collected.The patients were divided into two groups:early-and late-onset groups which were defined as diagnosis at<40 years old(n=768)and≥40 years old(n=2860).The average age of the early-onset group was(41±11)years,of which 71.1%were male(546 cases),and the average age of the late-onset group was(63±10)years,of which 59.1%were male(1690 cases).Medical history and physical examination data were collected,including course of disease,body mass index,family history of diabetes,etc.Fasting plasma glucose(FPG)and glycated hemoglobin A1c were also measured.Independent sample t-test,chi-square test,Mann-Whitney U test and binary logistic regression were used to analyze the clinical characteristics of the patients with early-onset T2DM and related risk factors of chronic complications.Additive models were used to analyze the interaction between early onset T2DM and diabetes duration on chronic complications.We further compared the change of their metabolic index between early and late-onset groups in newly-diagnosed patients(diabetes duration<1 year).Results Compared with the late-onset T2DM group,the proportion of patients with a family history of diabetes was higher in the early-onset group,and body mass index was higher(both P<0.01).The early-onset group had higher glycated hemoglobin A1c(9.2%±2.1%vs 8.7%±2.2%,t=-4.454,P<0.01)and more patients with microvascular complications[38.8%(298/768)vs 29.4%(841/2860),χ²=24.819,P<0.01].Early-onset T2DM and diabetes duration more than 10 years had an interaction effect on microvascular complications.Further adjustment of age,duration of diabetes,family history of diabetes,conventional cardiovascular risk factors and treatment regimen,the risk of diabetic kidney disease was still higher than that of the late-onset group(odds ratio 1.66,95%confidence interval:1.01-2.71,P<0.05).For newly diagnosed T2DM patients,after a median follow-up of 373 days,fasting blood glucose(FPG)decreased more in the early-onset group(ΔFPGearly-onset group-ΔFPGlate-onset group=-0.62 mmol/L,95%confidence interval:-1.18 mmol/L,-0.05 mmol/L).Conclusion Metabolic profiles of early-onset T2DM is poorer with higher prevalence of diabetic complications.Early intervention for early-onset T2DM should be emphasized.