Lancet Diabetes Endocrinol:回顾15年,糖尿病整体住院率下降,非糖尿病特异性疾病就诊原因有所增加,预防与管理皆应与时俱进!

2022-01-24 Naomi MedSci原创

近日,有研究人员调查了2003年-2018年英国糖尿病患者因癌症、肝病和常见感染等特定原因住院的整体趋势。糖尿病患者住院率下降,住院原因改变。传统的糖尿病并发症减少,而非糖尿病特异性疾病有所增加。

      糖尿病可导致多种并发症,包括急性代谢失调(如糖尿病酮症酸中毒)、大血管疾病(如冠状动脉粥样硬化心脏病)、脑卒中及微血管并发症(如糖尿病肾损害、视网膜病变及周围神经病) 。这些已知的并发症在很大程度上可以通过循证干预早期预防,糖尿病并发症的早期干预已成为糖尿病患者管理的的重点。

     先前的研究发现,这些传统糖尿病并发症的非致命发病率及全因死亡率均在下降。其中,死亡率下降主要归因于大血管疾病的减少; 然而,造成死亡率下降的因素可能有好有坏。队列研究和基于人口的死亡率监测也有证据表明,一系列广泛的非传统疾病在糖尿病患者中的发病率逐渐升高。这些非传统并发症包括常见感染、肝病、痴呆症以及多种特殊癌症。虽然并非糖尿病特有, 但每一种并发症都有其特有机制,糖尿病患者的死亡率一直在增加。2021年的研究发现,死亡风险的增加主要体现在,当前癌症是造成糖尿病患者和非糖尿病患者死亡风险最大的原因。

      糖尿病患者的发病和入院不仅仅是由于糖尿病特有并发症的发生,而大部分住院可能由其他疾病导致,且这一比例仍在不断增加。这些非特异性的并发症对于预防和临床上降低这一患者群体的发病率影响深远,但是以前少有研究对其进行研究。近日,有研究人员调查了2003年-2018年英国糖尿病患者因癌症、肝病和常见感染等特定原因住院的整体趋势,该研究发表在Lancet Diabetes Endocrinol期刊。

      在这个流行病学分析中,研究者从2003-2018年住院病人的临床实践研究数据链中确定了309874名18岁以上的糖尿病患者(1型/2型)。通过连续的横断面和随访产生了一个混合的流行和事件的糖尿病研究人群。使用了一个离散化的泊松回归模型来估计糖尿病男性和女性患者在17个原因分组中每年因特定原因住院的比率。生成了1:1年龄匹配和性别匹配的无糖尿病人群,以比较有糖尿病和无糖尿病人群的特定原因住院率。

  • 研究结果发现,在整个研究期间,糖尿病患者的所有原因住院率高于那些没有糖尿病的人。
  • 2003年,糖尿病本身和冠心病是造成过度就医的主要原因(定义为糖尿病患者和非糖尿病患者住院率的绝对差异)。
  • 到2018年,非传染性和非癌性呼吸道疾病、非糖尿病相关癌症以及缺血性心脏病是造成男性和女性过度住院的最常见原因。
  • 糖尿病患者的住院率下降,住院原因改变。几乎所有传统的糖尿病并发症组(血管疾病、截肢和糖尿病)都有所减少,而非糖尿病特异性疾病(癌症、感染、非传染性和非癌性呼吸道疾病)则有所增加。这些不同的趋势代表了住院原因的变化,以至于传统的糖尿病并发症在2003年占住院人数的50% 以上,但在2018年仅约占30% 。相比之下,同一时期因呼吸道感染住院的男性比例从3% 增加到10% ,女性从4% 增加到12% 。

      以上,对糖尿病患者超额风险和住院负担构成变化的解释意味着,预防和临床措施应当演变,以应对导致糖尿病患者持续超额住院的各种原因。

文献来源:Pearson-Stuttard J, Cheng YJ, Bennett J, et al. Trends in leading causes of hospitalisation of adults with diabetes in England from 2003 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol. 2022;10(1):46-57. doi:10.1016/S2213-8587(21)00288-6

 

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    2022-07-03 howi
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  7. [GetPortalCommentsPageByObjectIdResponse(id=1902689, encodeId=43d11902689b6, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Fri Sep 30 05:14:19 CST 2022, time=2022-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831447, encodeId=086d183144ea4, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Jul 03 11:14:19 CST 2022, time=2022-07-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991200, encodeId=788119912001c, content=<a href='/topic/show?id=b29c99594dd' target=_blank style='color:#2F92EE;'>#非糖尿病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99594, encryptionId=b29c99594dd, topicName=非糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Thu Mar 31 20:14:19 CST 2022, time=2022-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640036, encodeId=a4cf1640036c6, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Apr 12 03:14:19 CST 2022, time=2022-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761825, encodeId=602a1e618253a, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Fri Jul 29 00:14:19 CST 2022, time=2022-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1899537, encodeId=4963189953e5a, content=<a href='/topic/show?id=6f746e94170' target=_blank style='color:#2F92EE;'>#特异性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67941, encryptionId=6f746e94170, topicName=特异性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Mon Dec 05 11:14:19 CST 2022, time=2022-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189214, encodeId=c1d71189214d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Sat Jan 29 23:34:00 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189053, encodeId=4f11118905314, content=糖尿病的预防尤其重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9c6d5397190, createdName=ms8000001722700191, createdTime=Sat Jan 29 10:43:42 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1188508, encodeId=2ace118850878, content=糖尿病并发症可怕。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cbcd5675699, createdName=moyanju2796, createdTime=Thu Jan 27 07:25:49 CST 2022, time=2022-01-27, status=1, ipAttribution=)]
    2022-01-29 屋顶瞄爱赏月

    学习了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1902689, encodeId=43d11902689b6, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Fri Sep 30 05:14:19 CST 2022, time=2022-09-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831447, encodeId=086d183144ea4, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sun Jul 03 11:14:19 CST 2022, time=2022-07-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1991200, encodeId=788119912001c, content=<a href='/topic/show?id=b29c99594dd' target=_blank style='color:#2F92EE;'>#非糖尿病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99594, encryptionId=b29c99594dd, topicName=非糖尿病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Thu Mar 31 20:14:19 CST 2022, time=2022-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1640036, encodeId=a4cf1640036c6, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Apr 12 03:14:19 CST 2022, time=2022-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761825, encodeId=602a1e618253a, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Fri Jul 29 00:14:19 CST 2022, time=2022-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1899537, encodeId=4963189953e5a, content=<a href='/topic/show?id=6f746e94170' target=_blank style='color:#2F92EE;'>#特异性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67941, encryptionId=6f746e94170, topicName=特异性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc7a157, createdName=jinweidong, createdTime=Mon Dec 05 11:14:19 CST 2022, time=2022-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189214, encodeId=c1d71189214d0, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211111/81c0b64745c644319545ec26d7ef0b34/9ddb2864d5df4dd9bf4305e380bffc96.jpg, createdBy=c7835705079, createdName=屋顶瞄爱赏月, createdTime=Sat Jan 29 23:34:00 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1189053, encodeId=4f11118905314, content=糖尿病的预防尤其重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9c6d5397190, createdName=ms8000001722700191, createdTime=Sat Jan 29 10:43:42 CST 2022, time=2022-01-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1188508, encodeId=2ace118850878, content=糖尿病并发症可怕。, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cbcd5675699, createdName=moyanju2796, createdTime=Thu Jan 27 07:25:49 CST 2022, time=2022-01-27, status=1, ipAttribution=)]
    2022-01-29 ms8000001722700191

    糖尿病的预防尤其重要

    0

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    2022-01-27 moyanju2796

    糖尿病并发症可怕。

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