The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMC Endocr Disord. 2010 Aug 10;10:14. doi: 10.1186/1472-6823-10-14.
At diabetes diagnosis major decisions about life-style changes and treatments are made based on characteristics measured shortly after diagnosis. The predictive value for mortality of these early characteristics is widely unknown. We examined the predictive value of patient characteristics measured shortly after diabetes diagnosis for 5-year all-cause and cardiovascular mortality with special reference to self-rated general health.
Data were from a population-based sample of 1,323 persons newly diagnosed with clinical diabetes and aged 40 years or over. Possible predictors of mortality were investigated in Cox regression models.
Multivariately patients who rated their health less than excellent experienced increased all-cause and cardiovascular mortality. These end-points also increased with sedentary life-style, relatively young age at diagnosis and presence of cardiovascular disease (CVD) at diagnosis. Further predictors of all-cause mortality were male sex, low body mass index and cancer, while cardiovascular mortality increased with urinary albumin concentration.
We found that patients who rated their health as less than excellent had increased 5-year mortality, similar to that of patients with prevalent CVD, even when biochemical, clinical and life-style variables were controlled for. This finding could motivate doctors to discuss perceptions of health with newly diagnosed diabetic patients and be attentive to patients with suboptimal health ratings. Our findings also confirm that life-style changes and optimizing treatment are particularly relevant for relatively young and inactive patients and those who already have CVD or (micro)albuminuria at the time of diabetes diagnosis.
在诊断糖尿病时，根据诊断后不久测量的特征，做出关于生活方式改变和治疗的重大决策。这些早期特征对死亡率的预测价值尚不清楚。我们研究了糖尿病诊断后不久测量的患者特征对 5 年全因和心血管死亡率的预测价值，特别关注自我评估的总体健康状况。
数据来自一项基于人群的样本，共 1323 名新诊断为临床糖尿病且年龄在 40 岁或以上的患者。使用 Cox 回归模型研究了死亡率的可能预测因素。
在多变量分析中，自我评估健康状况不佳的患者全因和心血管死亡率增加。这些终点也随着久坐的生活方式、诊断时相对年轻的年龄和诊断时存在心血管疾病（CVD）而增加。全因死亡率的进一步预测因素是男性、低体重指数和癌症，而心血管死亡率则随着尿白蛋白浓度的增加而增加。
我们发现，自我评估健康状况不佳的患者 5 年死亡率增加，与已患有 CVD 的患者相似，即使控制了生化、临床和生活方式变量。这一发现可能促使医生与新诊断的糖尿病患者讨论健康感知，并关注健康状况不佳的患者。我们的研究结果还证实，生活方式的改变和治疗的优化对于相对年轻、不活跃的患者以及在糖尿病诊断时已经患有 CVD 或（微量）白蛋白尿的患者尤为重要。
