ACC2021:糖尿病前期为时已晚吗?重大不良心血管事件几乎翻一倍!

2021-05-08 Dr.Sun Nutrition & Health MedSci原创

糖尿病前期是平均血糖含量增高但不足以诊断为2型糖尿病的一种情况。虽然2型糖尿病是心脏病发作、中风和心脏动脉阻塞的众所周知的主要危险因素,但糖尿病前期的影响却不太明确。然而,糖尿病前期是相当常见的。据美

糖尿病前期是平均血糖含量增高但不足以诊断为2型糖尿病的一种情况。虽然2型糖尿病是心脏病发作、中风和心脏动脉阻塞的众所周知的主要危险因素,但糖尿病前期的影响却不太明确。然而,糖尿病前期是相当常见的。据美国疾病控制和预防中心估计,3400万美国人(略高于十分之一)患有糖尿病,另有8800万人(大约三分之一)患有糖尿病前期。

与糖尿病一样,糖尿病前期的诊断基于血糖检测的结果,包括A1C,A1C反映了某人过去两到三个月的平均血糖;空腹血糖检测,在你事先至少八个小时未进饮食之后检测你的血糖;和/或口服葡萄糖耐量试验,检查身体在喝过临床医生提供的甜饮料后对糖的处理情况。根据美国糖尿病学会的数据,糖尿病前期的限定值为A1C在5.7-6.4%之间,空腹血糖为100-125 mg/dl,或口服葡萄糖耐量试验为140-199mg/dl。

根据美国心脏病学会第70届年度科学会议上发布的研究,糖尿病前期患者与血糖水平正常的人相比,患心脏病、中风或其他重大血管事件的可能性要大得多。研究人员说,这一发现应该给临床医生和患者敲响警钟,首先要努力预防糖尿病前期。

“一般来说,我们倾向于将糖尿病前期视为没什么大不了的。但我们发现,糖尿病前期本身可以显著提高某人发生重大心血管事件的机会,即使他们从未进展到患上糖尿病,”内科住院医师阿德里安·米歇尔(Adrian Michel, MD)说,他是密歇根皇家橡树博蒙特医院的内科住院医师,也是这项研究的主要作者,他说,这是迄今为止规模最大的研究之一。“我们需要转移注意力,预防糖尿病前期而不是预防糖尿病。”

这项研究显示,在五年的随访中位数内,18%的糖尿病前期患者发生严重的心血管事件,相比之下,血糖水平正常的人只有11%发生。即使考虑到可能产生影响的其他因素,如年龄、性别、体重指数、血压、胆固醇、睡眠呼吸暂停、吸烟和外周动脉疾病,血糖水平升高与心血管事件之间的关系仍然显著。

“根据我们的数据,患有糖尿病前期发生重大不良心血管事件的可能性几乎增加了一倍,重大不良心血管事件占美国死亡人数的1/4。”Michel说,“作为临床医生,我们需要花更多的时间教育我们的患者血糖水平升高的风险及其对心脏健康的意义,并考虑更早或更积极地开始药物治疗,并就改变危险因素提供建议,包括关于锻炼和采用健康饮食的建议。

特别令人关切的是,即使糖尿病前期组的患者能够使他们的血糖水平恢复正常,发生心血管事件的风险仍然相当高。这些患者中有10.5%以上发生心血管事件,而没有糖尿病或糖尿病前期的人中只有6%发生。

Michel说:“即使血糖水平恢复到正常范围,这并没有真正改变他们增高的心血管事件发生风险,因此从一开始就预防糖尿病前期可能是最好的方法。

这项单中心回顾性研究纳入了2006年至2020年间在密歇根州博蒙特卫生系统接受治疗的25,829名患者的数据。然后,根据至少两个间隔五年的A1C水平将患者分成糖尿病前期或对照组;对照组包括在研究期间保持正常糖化血红蛋白的患者。糖尿病前期和对照组分别包括12,691名患者和13,138名患者。参与者的年龄从18岁到104岁不等。所有患者都进行了为期14年的随访研究,研究人员使用国际疾病分类代码或诊断代码来确定是否发生了重大心血管不良事件。

糖尿病前期和心血管事件之间的关系在男性、黑人和有心血管疾病家族史或个人心脏病危险因素的人中最为密切。在所有患者中,超重的人的心血管事件发生率最高,甚至比肥胖者还要高,Michel说,这需要进一步研究。

糖尿病前期被认为对心脏健康具有一定影响,因为血糖水平升高会损伤血管并引起炎症。Michel说,这会导致体内的血管损伤,并可能导致血管狭窄,并最终导致心血管损伤。

综上,研究表明,糖尿病前期与重大心血管不良事件的发病率显著增加相关,正常化糖尿病前期的糖化血红蛋白似乎不会降低重大心血管不良事件的风险。这表明糖尿病前期患者的管理应侧重于预防向糖尿病进展。这项研究结果郑重提醒成年人了解他们的血糖数值,特别是因为糖尿病前期通常没有症状。需要更多的研究来验证这些发现。

Michel将于美国东部时间5月16日星期日下午2:30/国际协调时间18:30发布这项研究,“Prediabetes Associated with an Increase in Major Adverse Cardiovascular Events”。

原始出处:

Adrian Michel, Ramy Mando et al. PREDIABETES ASSOCIATED WITH AN INCREASE IN MAJOR ADVERSE CARDIOVASCULAR EVENTS. J Am Coll Cardiol. 2021 May, 77 (18_Supplement_2) 14

Ramy Mando , Adrian Michel et al. IS PREDIABETES TOO LATE? NORMALIZATION OF HEMOGLOBIN A1C IN PREDIABETES IS NOT ASSOCIATED WITH IMPROVED OUTCOMES. J Am Coll Cardiol. 2021 May, 77 (18_Supplement_1) 1603

 

 

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    2021-05-08 12186752m54暂无昵称

    学习了

    0

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    2021-05-08 T2DM终结者

    糖尿病前期不是糖尿病,但还是个病

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1643741, encodeId=d0441643e41b3, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Mon Mar 28 22:30:20 CST 2022, time=2022-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326786, encodeId=cd071326e86fe, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun May 09 04:30:20 CST 2021, time=2021-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963678, encodeId=5cdf9636e8bb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210319/11a5cd980a9d460da3309d2f9b731d89/6bc10897e4c7451ab7a1b02b57b06c50.jpg, createdBy=9c9c2261743, createdName=12186752m54暂无昵称, createdTime=Sat May 08 11:50:05 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963568, encodeId=f2e096356842, content=糖尿病前期不是糖尿病,但还是个病, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Sat May 08 00:55:29 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043593, encodeId=0d3e1043593b1, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Fri May 07 16:30:20 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963393, encodeId=4fe8963393e9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=78f72514592, createdName=海1991, createdTime=Fri May 07 14:30:52 CST 2021, time=2021-05-07, status=1, ipAttribution=)]
    2021-05-07 misszhang

    谢谢MedSci提供最新的资讯

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1643741, encodeId=d0441643e41b3, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Mon Mar 28 22:30:20 CST 2022, time=2022-03-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326786, encodeId=cd071326e86fe, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun May 09 04:30:20 CST 2021, time=2021-05-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963678, encodeId=5cdf9636e8bb, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210319/11a5cd980a9d460da3309d2f9b731d89/6bc10897e4c7451ab7a1b02b57b06c50.jpg, createdBy=9c9c2261743, createdName=12186752m54暂无昵称, createdTime=Sat May 08 11:50:05 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963568, encodeId=f2e096356842, content=糖尿病前期不是糖尿病,但还是个病, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210226/f23705539a22465dad49b185641246f4/269e005bb68348558ceb01a4a8056073.jpg, createdBy=a54d5390453, createdName=T2DM终结者, createdTime=Sat May 08 00:55:29 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1043593, encodeId=0d3e1043593b1, content=谢谢MedSci提供最新的资讯, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Fri May 07 16:30:20 CST 2021, time=2021-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=963393, encodeId=4fe8963393e9, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=78f72514592, createdName=海1991, createdTime=Fri May 07 14:30:52 CST 2021, time=2021-05-07, status=1, ipAttribution=)]
    2021-05-07 海1991

    学习了

    0