Lorenzo C, Nath S D, Hanley A J G, Abboud H E, Gelfond J A L, Haffner S M
Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7873, USA.
Diabetologia. 2009 Jul;52(7):1290-7. doi: 10.1007/s00125-009-1361-4. Epub 2009 Apr 15.
AIMS/HYPOTHESIS: Metabolic abnormalities frequently develop prior to the diagnosis of type 2 diabetes and chronic kidney disease. However, it is not known whether GFR predicts the onset of type 2 diabetes.
Incident diabetes was ascertained in the Insulin Resistance Atherosclerosis Study (IRAS) (n = 864; age 40-69 years; median follow-up 5.2 years [4.5-6.6 years]; 141 incident cases of diabetes). GFR was estimated by the Modification of Diet in Renal Disease equation. We assessed the relationship between GFR and incident diabetes by logistic regression analysis. Results were adjusted for age, sex, ethnicity, clinic location, BMI, systolic blood pressure, antihypertensive treatment, family history of diabetes, insulin sensitivity and secretion, albumin to creatinine ratio, and levels of triacylglycerols, HDL-cholesterol, plasminogen activator inhibitor-1, and fasting and 2 h glucose.
The relationship between GFR and incident diabetes was not linear. This relationship was statistically significant (p = 0.039) using a restricted cubic polynomial spline for GFR as a regression modelling strategy. Participants were stratified by GFR quintiles. Mean values for GFR from the first to the fifth quintile were 60.8, 71.6, 79.8, 88.2 and 109.0 ml min(-1) 1.73 m(-2). Relative to the fourth quintile, the odds ratios of incident diabetes for the first, second, third and fifth quintiles were 2.32 (95% CI 1.06-5.05), 1.76 (95% CI 0.80-3.88), 1.26 (95% CI 0.56-2.84) and 2.59 (95% CI 1.18-5.65), respectively.
CONCLUSIONS/INTERPRETATION: Individuals in the upper and lower ranges of GFR are at increased risk of future diabetes. GFR and type 2 diabetes may share common pathogenic mechanisms.
目的/假设：代谢异常常在2型糖尿病和慢性肾脏病诊断之前出现。然而，肾小球滤过率（GFR）是否能预测2型糖尿病的发病尚不清楚。
在胰岛素抵抗动脉粥样硬化研究（IRAS）中确定新发糖尿病情况（n = 864；年龄40 - 69岁；中位随访时间5.2年[4.5 - 6.6年]；141例糖尿病新发病例）。采用肾脏病饮食改良公式估算GFR。通过逻辑回归分析评估GFR与新发糖尿病之间的关系。结果针对年龄、性别、种族、诊所位置、体重指数、收缩压、降压治疗、糖尿病家族史、胰岛素敏感性和分泌、白蛋白与肌酐比值以及甘油三酯、高密度脂蛋白胆固醇、纤溶酶原激活物抑制剂-1水平以及空腹和2小时血糖水平进行了校正。
GFR与新发糖尿病之间的关系并非呈线性。使用受限立方多项式样条将GFR作为回归建模策略时，这种关系具有统计学意义（p = 0.039）。参与者按GFR五分位数分层。从第一到第五五分位数的GFR均值分别为60.8、71.6、79.8、88.2和109.0 ml·min⁻¹·1.73 m⁻²。相对于第四五分位数，第一、第二、第三和第五五分位数新发糖尿病的比值比分别为2.32（95%可信区间1.06 - 5.05）、1.76（95%可信区间0.80 - 3.88）、1.26（95%可信区间0.56 - 2.84）和2.59（95%可信区间1.18 - 5.65）。
结论/解读：GFR处于较高和较低范围的个体未来患糖尿病的风险增加。GFR与2型糖尿病可能具有共同的致病机制。
