University of Dundee, Dundee, United Kingdom.
PLoS Med. 2012;9(10):e1001321. doi: 10.1371/journal.pmed.1001321. Epub 2012 Oct 2.
Randomized controlled trials have shown the importance of tight glucose control in type 1 diabetes (T1DM), but few recent studies have evaluated the risk of cardiovascular disease (CVD) and all-cause mortality among adults with T1DM. We evaluated these risks in adults with T1DM compared with the non-diabetic population in a nationwide study from Scotland and examined control of CVD risk factors in those with T1DM.
The Scottish Care Information-Diabetes Collaboration database was used to identify all people registered with T1DM and aged ≥20 years in 2005-2007 and to provide risk factor data. Major CVD events and deaths were obtained from the national hospital admissions database and death register. The age-adjusted incidence rate ratio (IRR) for CVD and mortality in T1DM (n = 21,789) versus the non-diabetic population (3.96 million) was estimated using Poisson regression. The age-adjusted IRR for first CVD event associated with T1DM versus the non-diabetic population was higher in women (3.0: 95% CI 2.4-3.8, p<0.001) than men (2.3: 2.0-2.7, p<0.001) while the IRR for all-cause mortality associated with T1DM was comparable at 2.6 (2.2-3.0, p<0.001) in men and 2.7 (2.2-3.4, p<0.001) in women. Between 2005-2007, among individuals with T1DM, 34 of 123 deaths among 10,173 who were <40 years and 37 of 907 deaths among 12,739 who were ≥40 years had an underlying cause of death of coma or diabetic ketoacidosis. Among individuals 60-69 years, approximately three extra deaths per 100 per year occurred among men with T1DM (28.51/1,000 person years at risk), and two per 100 per year for women (17.99/1,000 person years at risk). 28% of those with T1DM were current smokers, 13% achieved target HbA(1c) of <7% and 37% had very poor (≥9%) glycaemic control. Among those aged ≥40, 37% had blood pressures above even conservative targets (≥140/90 mmHg) and 39% of those ≥40 years were not on a statin. Although many of these risk factors were comparable to those previously reported in other developed countries, CVD and mortality rates may not be generalizable to other countries. Limitations included lack of information on the specific insulin therapy used.
Although the relative risks for CVD and total mortality associated with T1DM in this population have declined relative to earlier studies, T1DM continues to be associated with higher CVD and death rates than the non-diabetic population. Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed. Please see later in the article for the Editors' Summary.
随机对照试验已经证明了在 1 型糖尿病（T1DM）中严格控制血糖的重要性，但最近很少有研究评估 T1DM 成年人患心血管疾病（CVD）和全因死亡率的风险。我们在一项来自苏格兰的全国性研究中比较了 T1DM 成年人与非糖尿病人群的这些风险，并检查了 T1DM 患者 CVD 风险因素的控制情况。
苏格兰护理信息-糖尿病合作数据库被用于确定 2005-2007 年登记的年龄≥20 岁的所有 T1DM 患者，并提供风险因素数据。主要 CVD 事件和死亡从国家住院数据库和死亡登记处获得。使用泊松回归估计 T1DM（n=21789）与非糖尿病人群（3960 万）相比 CVD 和死亡率的年龄调整发病率比（IRR）。与非糖尿病人群相比，女性（3.0：95%CI 2.4-3.8，p<0.001）T1DM 相关首次 CVD 事件的年龄调整 IRR 高于男性（2.3：2.0-2.7，p<0.001），而与 T1DM 相关的全因死亡率的 IRR 男性为 2.6（2.2-3.0，p<0.001），女性为 2.7（2.2-3.4，p<0.001）。在 2005-2007 年期间，在 10173 名年龄<40 岁的 123 例死亡患者和 12739 名年龄≥40 岁的 907 例死亡患者中，有 34 例和 37 例的根本死因分别为昏迷或糖尿病酮症酸中毒。在 60-69 岁的患者中，男性 T1DM 患者每年每 100 人大约多发生 3 例死亡（风险 1000 人中 28.51/年），女性每年每 100 人多发生 2 例死亡（风险 1000 人中 17.99/年）。28%的 T1DM 患者为当前吸烟者，13%的患者达到 HbA1c 目标<7%，37%的患者血糖控制极差（≥9%）。在年龄≥40 岁的患者中，37%的患者血压高于甚至保守的目标值（≥140/90mmHg），39%的年龄≥40 岁的患者未服用他汀类药物。尽管这些危险因素中的许多与其他发达国家之前报道的相似，但 CVD 和死亡率可能无法推广到其他国家。局限性包括缺乏特定胰岛素治疗使用的信息。
尽管与该人群的 T1DM 相关的 CVD 和全因死亡率的相对风险与早期研究相比有所下降，但 T1DM 与非糖尿病人群相比，CVD 和死亡率仍然较高。应改善危险因素管理以进一步降低风险，但迫切需要更好的治疗方法来实现良好的血糖控制。请在文章后面查看编辑摘要。
