Shankar Anoop, Klein Ronald, Klein Barbara E K, Moss Scot E
Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Am J Epidemiol. 2007 Aug 15;166(4):393-402. doi: 10.1093/aje/kwm096. Epub 2007 May 25.
Hyperglycemia is implicated in the development and progression of microvascular complications in type 1 diabetes. In contrast, the association between hyperglycemia and macrovascular complications or mortality in type 1 diabetes is not clear. The authors studied a population-based cohort of 879 individuals with type 1 diabetes from Wisconsin, free of cardiovascular disease and end-stage renal disease at the baseline examination (1980-1982). The main outcome of interest was all-cause (n=201) and cardiovascular (n=132) mortality as of December 31, 2001. Elevated glycosylated hemoglobin levels were associated with all-cause and cardiovascular mortality, independent of duration of diabetes, smoking, hypertension, and proteinuria. The multivariable relative risks comparing the highest quartile of glycosylated hemoglobin (>or=12.1%) with the lowest quartile (<or=9.4%) were 2.42 (95% confidence interval: 1.54, 3.82; p-trend=0.0006) for all-cause mortality and 3.28 (95% confidence interval: 1.77, 6.08; p-trend<0.0001) for cardiovascular mortality. This association was present among both sexes and persisted in subgroup analyses by categories of diabetes duration, smoking, body mass index, proteinuria, and retinopathy. These data suggest that hyperglycemia is associated with all-cause and cardiovascular mortality among individuals with type 1 diabetes.
高血糖与1型糖尿病微血管并发症的发生和发展有关。相比之下，高血糖与1型糖尿病大血管并发症或死亡率之间的关联尚不清楚。作者对来自威斯康星州的879名1型糖尿病患者进行了一项基于人群的队列研究，这些患者在基线检查（1980 - 1982年）时无心血管疾病和终末期肾病。主要关注的结局是截至2001年12月31日的全因死亡（n = 201）和心血管死亡（n = 132）。糖化血红蛋白水平升高与全因死亡和心血管死亡相关，且独立于糖尿病病程、吸烟、高血压和蛋白尿。将糖化血红蛋白最高四分位数（≥12.1%）与最低四分位数（≤9.4%）进行比较的多变量相对风险，全因死亡为2.42（95%置信区间：1.54，3.82；p趋势 = 0.0006），心血管死亡为3.28（95%置信区间：1.77，6.08；p趋势<0.0001）。这种关联在男女中均存在，并且在按糖尿病病程、吸烟、体重指数、蛋白尿和视网膜病变分类的亚组分析中持续存在。这些数据表明，高血糖与1型糖尿病患者的全因死亡和心血管死亡相关。
