Ostgren C J, Lindblad U, Ranstam J, Melander A, Råstam L
Department of Community Medicine, Malmö University Hospital, Malmö, Sweden.
Diabet Med. 2002 Feb;19(2):125-9. doi: 10.1046/j.1464-5491.2002.00661.x.
To examine determinants for glycaemic control in primary care patients with Type 2 diabetes.
In a community-based surveillance of primary care patients with Type 2 diabetes, 190 men and 186 women were consecutively identified and examined for cardiovascular risk factors. Insulin resistance and beta-cell function were estimated using homeostasis model assessment (HOMA). Good glycaemic control was defined as HbA(1c) < 6.5%.
Following adjustment for age and gender, HbA(1c) > or = 6.5% was associated with duration of diabetes (10.6 vs. 6.4 years, P < 0.001), lower levels of serum insulin (6.3 vs. 8.0 mU/l, P = 0.012), higher serum triglyceride levels (2.0 vs. 1.7 mmol/l, P = 0.002) and impairment of beta-cell function (HOMA index 19.5 vs. 45.8, P < 0.001). The association between HbA(1c) levels and duration remained with adjustment for age, gender, waist-hip ratio (WHR) and serum triglycerides (odds ratio (OR) for HbA(1c) > or = 6.5% by 5 years diabetes duration = 1.7; 95% confidence interval (CI) 1.4--2.1) but was lost following additional adjustment for beta-cell function (OR for HbA(1c) > or = 6.5% = 1.3; 95% CI 0.96-1.7). In a separate linear regression with beta-cell function as the dependent variable there was a significant association with HbA1c after adjustments for differences in age, gender, WHR, serum triglyceride levels and diabetes duration (P < 0.001).
Increasing HbA1c by time was associated with declining beta-cell function.
研究基层医疗中2型糖尿病患者血糖控制的决定因素。
在一项针对基层医疗2型糖尿病患者的社区监测中，连续纳入190名男性和186名女性，并对其心血管危险因素进行检查。采用稳态模型评估（HOMA）来估计胰岛素抵抗和β细胞功能。血糖控制良好定义为糖化血红蛋白（HbA1c）<6.5%。
在对年龄和性别进行校正后，HbA1c≥6.5%与糖尿病病程（10.6年对6.4年，P<0.001）、较低的血清胰岛素水平（6.3 mU/l对8.0 mU/l，P=0.012）、较高的血清甘油三酯水平（2.0 mmol/l对1.7 mmol/l，P=0.002）以及β细胞功能受损（HOMA指数19.5对45.8，P<0.001）相关。在对年龄、性别、腰臀比（WHR）和血清甘油三酯进行校正后，HbA1c水平与病程之间仍存在关联（糖尿病病程5年时HbA1c≥6.5%的比值比（OR）=1.7；95%置信区间（CI）1.4-2.1），但在进一步对β细胞功能进行校正后这种关联消失（HbA1c≥6.5%的OR=1.3；95%CI 0.96-1.7）。在一项以β细胞功能为因变量的单独线性回归中，在校正年龄、性别、WHR、血清甘油三酯水平和糖尿病病程的差异后，与HbA1c存在显著关联（P<0.001）。
随着时间推移HbA1c升高与β细胞功能下降相关。
