Diabetes Care:你的糖化还好吗?既往HbA1c可能决定未来20年糖尿病进展!

2021-10-12 MedSci原创 MedSci原创

遗留效应被认为是糖尿病及其并发症之间的桥梁,也是血糖管理的挑战。

前期,一项英国前瞻性糖尿病研究(UKPDS)表明,强化血糖控制,与常规血糖控制相比,HbA1c水平平均降低0.9%,降低了2型糖尿病(T2D)患者的微血管并发症风险。全因死亡(ACM)和心肌梗死(MI)的风险并没有降低,尽管16%的MI风险降低在统计学上有边缘意义(P = 0.052)。

随后,一项关于控制糖尿病心血管风险行动(ACCORD)、糖尿病和血管疾病行动的患者层面的荟萃分析。结果显示包括Preterax和Diamicron MR对照评估(ADVANCE)、UKPDS和退伍军人事务糖尿病试验(VADT)等研究结果证实HbA1c降低0.88%时,MI风险降低15%。

糖尿病患者的早期高血糖若不能得到及时有效的控制,即使后期采取措施控制良好,仍易发生糖尿病慢性并发症,这种现象被称为“遗留效应”,也叫做“代谢记忆”。目前,遗留效应被认为是糖尿病及其并发症之间的桥梁,也是血糖管理的挑战。

为了探讨血糖遗留效应与既往HbA1c值的关系,并探讨了早期降糖治疗与延迟降糖治疗的潜在影响,来自瑞典哥德堡大学Sahlgrenska学院医学研究所的专家开展了相关研究,结果发表在Diabetes Care杂志上。

研究人员从3802名英国前瞻性糖尿病研究(UKPDS 88)参与者的T2D诊断开始,估计了20年的ACM和MI危险函数。根据HbA1c值对下游ACM和MI风险的影响进行加权分析。

结果显示,HbA1c每升高一个百分点,5年、10年和20年的ACM危险分别增加8%、18%、36%(HR=1.08,95% CI 1.07-1.09;1.18,1.15-1.21;1.36,1.30-1.42);5年的MI危险增加13%(HR=1.13,1.11-1.15),20年增加到31%(HR=1.31,1.25-1.36)。

2型糖尿病诊断后0至20年内所有原因死亡(左)和心肌梗死(右)的时间依赖性HR。

另一方面,从诊断开始将HbA1c降低一个百分点,10-15年后ACM风险降低18.8%(95% CI 21.1-16.0),而将这种降低推迟到诊断后10年,风险仅为1/7,即2.7%(3.1-2.3)。在诊断时降低HbA1c,相应的MI风险降低了19.7%(22.4-16.5),而在10年后实施时,MI风险降至1/3,为6.5%(7.4-5.3%)。

综上,早期发现糖尿病并从诊断时开始强化血糖控制,对于最大限度地降低血糖并发症的长期风险至关重要。

 

参考文献:

Historical HbA1c Values May Explain the Type 2 Diabetes Legacy Effect: UKPDS 88. Diabetes Care 2021 Oct; 44(10): 2231-2237. https://doi.org/10.2337/dc20-2439

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    2022-04-15 Smile2680
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