Circulation:1型糖尿病强化降糖体重增加过多升高并发症危险

2012-12-12 范伟伟译 Circulation

  近期两项前瞻性研究表明,体重增加过多(DCCT研究中)与持续增长的中心性肥胖、胰岛素抵抗、血脂异常、高血压,以及随访后期(EDIC研究中)更广泛的动脉粥样硬化相关。研究于2012年12月3日在线发表于《循环》(Circulation)杂志。   1型糖尿病(T1DM)的强化降糖治疗可减少糖尿病并发症,但可伴有体重增加过多、中心性肥胖和血脂异常。该前瞻性研究目的在于确定1型糖尿病患者糖尿病治疗

  近期两项前瞻性研究表明,体重增加过多(DCCT研究中)与持续增长的中心性肥胖、胰岛素抵抗、血脂异常、高血压,以及随访后期(EDIC研究中)更广泛的动脉粥样硬化相关。研究于2012年12月3日在线发表于《循环》(Circulation)杂志。

  1型糖尿病(T1DM)的强化降糖治疗可减少糖尿病并发症,但可伴有体重增加过多、中心性肥胖和血脂异常。该前瞻性研究目的在于确定1型糖尿病患者糖尿病治疗伴随的过度体重增加是否与动脉粥样硬化性疾病相关。

  T1DM受试者(97%为白人,45%为女性,平均年龄35岁)来自糖尿病控制与并发症试验(DCCT),随机分配为强化降糖治疗(INT)组或常规降糖治疗(CONV)组。在后续的糖尿病干预和并发症流行病学(EDIC)研究中,对受试者的颈动脉内膜中膜厚度(IMT)(N=1015)进行测量和冠状动脉钙化(CAC)进行评分(n=925)。DCCT研究期间,INT受试者依照体质指数(BMI)变化的四分位数进行分类。

  结果表明,过度体重增加的受试者(第四四分位数,包括达到这一阈值的CONV组受试者)较体重最小涨幅的受试者保持更高的BMI和腰围(WC),需要更多的胰岛素治疗,有更大的IMT(+5%,P<0.001 EDIC第1年,P=0.003,EDIC第6年),并趋向于更高的CAC评分(OR 1.55,CI 0.97-2.49,P=0.07)。DCCT 研究WC和血压都符合代谢综合征标准的受试者在两个EDIC随访年均有较高的IMT(P=0.02~<0.001);符合HDL标准的受试者在随访期间有更高的CAC评分(OR 1.6,CI 1.1-2.4,P=0.01)。对于INT组但非CONV组,更常见的糖尿病家族病史、高血压和高脂血症与更大的IMT厚度相关。


The Effect of Excess Weight Gain with Intensive Diabetes Treatment on Cardiovascular Disease Risk Factors and Atherosclerosis in Type 1 Diabetes: Results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) Study

Background

Intensive diabetes therapy of type 1 diabetes (T1DM) reduces diabetes complications but can be associated with excess weight gain, central obesity, and dyslipidemia. The purpose of this study was to determine if excessive weight gain with diabetes therapy of T1DM is prospectively associated with atherosclerotic disease.

Methods and Results

Subjects with T1DM (97% Caucasian, 45% female, mean age 35 years) randomly assigned to intensive (INT) or conventional (CONV) diabetes treatment during the Diabetes Control and Complications Trial (DCCT) underwent intima-media thickness (IMT) (n=1015) and coronary artery calcium (CAC) score (n=925) measurements during follow-up in the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. INT subjects were classified by quartile of BMI change during the DCCT. Excess gainers (4th quartile, including CONV subjects meeting this threshold) maintained greater BMI and waist circumference (WC), needed more insulin, had greater IMT (+5%, P<0.001 EDIC year 1, P=0.003 EDIC year 6), and trended towards greater CAC scores (OR 1.55, CI 0.97 – 2.49, P=0.07) than minimal gainers. DCCT subjects meeting metabolic syndrome criteria for WC and blood pressure had greater IMT in both EDIC years (P=0.02 to <0.001); those meeting HDL criteria had greater CAC scores (OR 1.6 and CI 1.1 – 2.4, P=0.01) during follow-up. Increasing frequency of a family history of diabetes, hypertension, and hyperlipidemia was associated with greater IMT thickness with INT but not CONV.

Conclusions

Excess weight gain in DCCT is associated with sustained increases in central obesity, insulin resistance, dyslipidemia and blood pressure, as well as more extensive atherosclerosis during EDIC.

1型糖尿病相关的拓展阅读:

   



    

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    2014-02-23 Victor

    I always spent my half an hour to read this weblog's articles
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    2013-03-17 丁鹏鹏
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