糖尿病、空腹血糖与特定病因死亡风险。
Diabetes mellitus, fasting glucose, and risk of cause-specific death.
机构信息
University of Cambridge, Cambridge, United Kingdom.
St. George's University of London, London.
出版信息
N Engl J Med. 2011 Mar 3;364(9):829-841. doi: 10.1056/NEJMoa1008862.
BACKGROUND
The extent to which diabetes mellitus or hyperglycemia is related to risk of death from cancer or other nonvascular conditions is uncertain.
METHODS
We calculated hazard ratios for cause-specific death, according to baseline diabetes status or fasting glucose level, from individual-participant data on 123,205 deaths among 820,900 people in 97 prospective studies.
RESULTS
After adjustment for age, sex, smoking status, and body-mass index, hazard ratios among persons with diabetes as compared with persons without diabetes were as follows: 1.80 (95% confidence interval [CI], 1.71 to 1.90) for death from any cause, 1.25 (95% CI, 1.19 to 1.31) for death from cancer, 2.32 (95% CI, 2.11 to 2.56) for death from vascular causes, and 1.73 (95% CI, 1.62 to 1.85) for death from other causes. Diabetes (vs. no diabetes) was moderately associated with death from cancers of the liver, pancreas, ovary, colorectum, lung, bladder, and breast. Aside from cancer and vascular disease, diabetes (vs. no diabetes) was also associated with death from renal disease, liver disease, pneumonia and other infectious diseases, mental disorders, nonhepatic digestive diseases, external causes, intentional self-harm, nervous-system disorders, and chronic obstructive pulmonary disease. Hazard ratios were appreciably reduced after further adjustment for glycemia measures, but not after adjustment for systolic blood pressure, lipid levels, inflammation or renal markers. Fasting glucose levels exceeding 100 mg per deciliter (5.6 mmol per liter), but not levels of 70 to 100 mg per deciliter (3.9 to 5.6 mmol per liter), were associated with death. A 50-year-old with diabetes died, on average, 6 years earlier than a counterpart without diabetes, with about 40% of the difference in survival attributable to excess nonvascular deaths.
CONCLUSIONS
In addition to vascular disease, diabetes is associated with substantial premature death from several cancers, infectious diseases, external causes, intentional self-harm, and degenerative disorders, independent of several major risk factors. (Funded by the British Heart Foundation and others.).
背景
糖尿病或高血糖与癌症或其他非血管疾病死亡风险的关系程度尚不确定。
方法
我们根据 97 项前瞻性研究中 820900 人的个体参与者数据，计算了基线时糖尿病状态或空腹血糖水平与特定原因死亡的风险比。
结果
在调整年龄、性别、吸烟状况和体重指数后，与无糖尿病者相比，糖尿病患者的以下风险比如下：1.80（95%置信区间[CI]，1.71 至 1.90）死于任何原因，1.25（95%CI，1.19 至 1.31）死于癌症，2.32（95%CI，2.11 至 2.56）死于血管原因，1.73（95%CI，1.62 至 1.85）死于其他原因。糖尿病（与无糖尿病）与肝癌、胰腺癌、卵巢癌、结直肠癌、肺癌、膀胱癌和乳腺癌的死亡中度相关。除癌症和血管疾病外，糖尿病（与无糖尿病）还与肾病、肝病、肺炎和其他传染病、精神障碍、非肝消化疾病、外部原因、故意自残、神经系统疾病和慢性阻塞性肺疾病的死亡相关。进一步调整血糖测量值后，风险比显著降低，但调整收缩压、血脂水平、炎症或肾脏标志物后则没有降低。空腹血糖水平超过 100mg/dL（5.6mmol/L），而不是 70 至 100mg/dL（3.9 至 5.6mmol/L），与死亡相关。一个 50 岁的糖尿病患者平均比无糖尿病的同龄人早死 6 年，其中约 40%的生存差异归因于非血管死亡过多。
结论
除血管疾病外，糖尿病与多种癌症、传染病、外部原因、故意自残和退行性疾病的过早死亡密切相关，且独立于多个主要危险因素。（由英国心脏基金会等资助）。
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