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

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7174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55058.50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。

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 7174 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 55058.50 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.