Department of Family Medicine, China Medical University, Taichung, Taiwan.
Am J Med. 2012 Apr;125(4):416.e9-18. doi: 10.1016/j.amjmed.2011.07.027. Epub 2012 Feb 2.
The aim of this study was to examine whether time-dependent annual fasting plasma glucose (FPG) variation, as represented by coefficient of variation (CV), can predict mortality in subsequent all-cause, expanded, and nonexpanded cardiovascular disease-related mortality independent of mean FPG, renal function, mean hemoglobin A(1)C (HbA(1C)), HbA(1C) variation, and other risk factors in patients with type 2 diabetes.
A computerized database of all patients with type 2 diabetes aged 30 years and over (n = 5008) enrolled in the Diabetes Care Management Program of China Medical University Hospital before 2007 was used in a time-dependent Cox proportional hazard regression model.
The mortality rates were 8.64, 12.71, and 30.82 per 1000 person-years in groups of first, second, and third tertiles of baseline FPG-CV, respectively. Among these patients with type 2 diabetes, 336, 1191, 914, 585, and 1979 patients provided 1, 2, 3, 4, and 5 or more years of annual FPG-CV measurements, respectively. After adjusting for mean FPG, mean HbA(1C), HbA(1C) variation, and other risk factors, annual FPG-CV was independently associated with all-cause mortality and mortality due to expanded and nonexpanded cardiovascular disease, and the corresponding hazard ratios for third versus first tertile of annual FPG-CV were 5.53 (95% confidence interval [CI], 3.85-7.94), 3.21 (95% CI, 2.00-5.15), and 9.45 (95% CI, 5.37-16.63), respectively.
Time-dependent variation of FPG was a strong predictor of all-cause, expanded, and nonexpanded cardiovascular disease-related mortality in patients with type 2 diabetes, suggesting that glucose variation may become a measure in clinical practice for the goal in the management of these patients.
本研究旨在探讨时间依赖性的年度空腹血糖（FPG）变化，以变异系数（CV）表示，是否可以独立于平均 FPG、肾功能、平均糖化血红蛋白 A1C（HbA1C）、HbA1C 变异以及其他风险因素，预测 2 型糖尿病患者随后的全因、扩大和非扩大心血管疾病相关死亡率。
使用中国医科大学附属医院糖尿病管理计划 2007 年前招募的所有年龄在 30 岁及以上的 2 型糖尿病患者的计算机化数据库，采用时间依赖性 Cox 比例风险回归模型。
第 1、2 和第 3 个三分位数组的基线 FPG-CV 分别为 8.64、12.71 和 30.82/1000 人年。在这些 2 型糖尿病患者中，分别有 336、1191、914、585 和 1979 名患者提供了 1、2、3、4 和 5 年或更长时间的年度 FPG-CV 测量。在校正平均 FPG、平均 HbA1C、HbA1C 变异和其他风险因素后，年度 FPG-CV 与全因死亡率以及扩大和非扩大心血管疾病死亡率独立相关，第 3 个三分位数组与第 1 个三分位数组的年度 FPG-CV 的相应危险比分别为 5.53（95%置信区间[CI]，3.85-7.94）、3.21（95%CI，2.00-5.15）和 9.45（95%CI，5.37-16.63）。
FPG 的时间依赖性变化是 2 型糖尿病患者全因、扩大和非扩大心血管疾病相关死亡率的强有力预测指标，提示血糖变异可能成为这些患者管理目标的临床实践中的一个衡量指标。
