Kronmal Richard A, Barzilay Joshua I, Smith Nicholas L, Psaty Bruce M, Kuller Lewis H, Burke Gregory L, Furberg Curt
Collaborative Heath Studies Coordinating Center and Department of Biostatistics, University of Washington, Seattle, Washington, United States of America.
PLoS Med. 2006 Oct;3(10):e400. doi: 10.1371/journal.pmed.0030400.
Diabetes mellitus (DM) confers an increased risk of mortality in young and middle-aged individuals and in women. It is uncertain, however, whether excess DM mortality continues beyond age 75 years, is related to type of hypoglycemic therapy, and whether women continue to be disproportionately affected by DM into older age.
From the Cardiovascular Health Study, a prospective study of 5,888 adults, we examined 5,372 participants aged 65 y or above without DM (91.2%), 322 with DM treated with oral hypoglycemic agents (OHGAs) (5.5%), and 194 with DM treated with insulin (3.3%). Participants were followed (1989-2001) for total, cardiovascular disease (CVD), coronary heart disease (CHD), and non-CVD/noncancer mortality. Compared with non-DM participants, those treated with OHGAs or insulin had adjusted hazard ratios (HRs) for total mortality of 1.33 (95% confidence interval [CI], 1.10 to 1.62) and 2.04 (95% CI, 1.62 to 2.57); CVD mortality, 1.99 (95% CI, 1.54 to 2.57) and 2.16 (95% CI, 1.54 to 3.03); CHD mortality, 2.47 (95% CI, 1.89 to 3.24) and 2.75 (95% CI, 1.95 to 3.87); and infectious and renal mortality, 1.35 (95% CI, 0.70 to 2.59) and 6.55 (95% CI, 4.18 to 10.26), respectively. The interaction of age (65-74 y versus > or =75 y) with DM was not significant. Women treated with OHGAs had a similar HR for total mortality to men, but a higher HR when treated with insulin.
DM mortality risk remains high among older adults in the current era of medical care. Mortality risk and type of mortality differ between OHGA and insulin treatment. Women treated with insulin therapy have an especially high mortality risk. Given the high absolute CVD mortality in older people, those with DM warrant aggressive CVD risk factor reduction.
糖尿病（DM）在中青年个体以及女性中会增加死亡风险。然而，超过75岁后糖尿病导致的额外死亡风险是否依然存在、是否与降糖治疗类型有关，以及女性在老年时是否继续受到糖尿病的不成比例影响尚不确定。
在心血管健康研究中，一项针对5888名成年人的前瞻性研究，我们调查了5372名65岁及以上无糖尿病的参与者（91.2%）、322名接受口服降糖药（OHGAs）治疗的糖尿病患者（5.5%）以及194名接受胰岛素治疗的糖尿病患者（3.3%）。对参与者进行随访（1989 - 2001年），观察全因、心血管疾病（CVD）、冠心病（CHD）以及非CVD/非癌症死亡率。与无糖尿病参与者相比，接受OHGAs或胰岛素治疗的参与者全因死亡的调整风险比（HRs）分别为1.33（95%置信区间[CI]，1.10至1.62）和2.04（95%CI，1.62至2.57）；CVD死亡率分别为1.99（95%CI，1.54至2.57）和2.16（95%CI，1.54至3.03）；CHD死亡率分别为2.47（95%CI，1.89至3.24）和2.75（95%CI，1.95至3.87）；感染和肾脏疾病死亡率分别为1.35（95%CI，0.70至2.59）和6.55（95%CI，4.18至10.26）。年龄（65 - 74岁与≥75岁）与糖尿病之间的交互作用不显著。接受OHGAs治疗的女性全因死亡的HR与男性相似，但接受胰岛素治疗时HR更高。
在当前医疗时代，老年成年人中糖尿病的死亡风险仍然很高。OHGAs和胰岛素治疗之间的死亡风险及死亡类型有所不同。接受胰岛素治疗的女性死亡风险尤其高。鉴于老年人中CVD的绝对死亡率很高，糖尿病患者需要积极降低CVD风险因素。
