Saydah S H, Loria C M, Eberhardt M S, Brancati F L
Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland, USA.
Diabetes Care. 2001 Mar;24(3):447-53. doi: 10.2337/diacare.24.3.447.
Although clinically evident type 2 diabetes is a well-established cause of mortality, less is known about subclinical states of glucose intolerance.
Data from the Second National Health and Nutrition Examination Survey Mortality Study, a prospective study of adults, were analyzed. This analysis focused on a nationally representative sample of 3,174 adults aged 30-75 years who underwent an oral glucose tolerance test at baseline (1976-1980) and who were followed up for death through 1992.
Using 1985 World Health Organization criteria, adults were classified as having previously diagnosed diabetes (n = 248), undiagnosed diabetes (n = 183), impaired glucose tolerance (IGT) (n = 480), or normal glucose tolerance (n = 2,263). For these groups, cumulative all-cause mortality through age 70 was 41, 34, 27, and 20%, respectively (P < 0.001). Compared with those with normal glucose tolerance, the multivariate adjusted RR of all-cause mortality was greatest for adults with diagnosed diabetes (RR 2.11, 95% CI 1.56-2.84), followed by those with undiagnosed diabetes (1.77, 1.13-2.75) and those with IGT (1.42, 1.08-1.87; P < 0.001). A similar pattern of risk was observed for cardiovascular disease mortality.
In the U.S., there was a gradient of mortality associated with abnormal glucose tolerance ranging from a 40% greater risk in adults with IGT to a 110% greater risk in adults with clinically evident diabetes. These associations were independent of established cardiovascular disease risk factors.
虽然临床诊断的2型糖尿病是公认的死亡原因，但对于葡萄糖耐量异常的亚临床状态了解较少。
对第二次全国健康与营养检查调查死亡率研究的数据进行了分析，该研究是一项针对成年人的前瞻性研究。本分析聚焦于3174名年龄在30 - 75岁的成年人的全国代表性样本，这些人在基线时（1976 - 1980年）接受了口服葡萄糖耐量试验，并随访至1992年的死亡情况。
根据1985年世界卫生组织标准，成年人被分类为患有先前诊断的糖尿病（n = 248）、未诊断的糖尿病（n = 183）、糖耐量受损（IGT）（n = 480）或糖耐量正常（n = 2263）。对于这些组，70岁时的累积全因死亡率分别为41%、34%、27%和20%（P < 0.001）。与糖耐量正常者相比，已诊断糖尿病的成年人全因死亡率的多变量调整相对危险度最高（RR 2.11，95% CI 1.56 - 2.84），其次是未诊断糖尿病者（1.77，1.13 - 2.75）和IGT者（1.42，1.08 - 1.87；P < 0.001）。心血管疾病死亡率也观察到类似的风险模式。
在美国，与葡萄糖耐量异常相关的死亡率存在梯度变化，从IGT成年人的风险增加40%到临床诊断糖尿病成年人的风险增加110%。这些关联独立于已确定的心血管疾病危险因素。
