Institution of Clinical Sciences in Lund, Lund University, Lund, Sweden.
Diabetologia. 2013 May;56(5):1140-7. doi: 10.1007/s00125-013-2860-x. Epub 2013 Feb 12.
AIMS/HYPOTHESIS: The increased all-cause mortality in patients with chronic diabetic foot ulcers cannot fully be explained by traditional cardiovascular risk factors. The significance of heart-rate-corrected QT (QTc) prolongation, a finding often seen in these patients, is unknown. Recently, the importance of metabolic control and hypoglycaemia has been discussed. The aim of this study was to evaluate the impact of different HbA1c levels and QTc prolongation on all-cause mortality in the high-risk population of patients with type 2 diabetes mellitus and foot ulcers.
All patients with type 2 diabetes, younger than 80 years, visiting our diabetes foot unit, with a foot ulcer duration >4 weeks, were screened for participation. Patients on dialysis were excluded. Patients were grouped according to HbA1c level and QTc time ≤ or > 440 ms.
Patients (n = 214, median age 69.1 years) were grouped according to HbA1c level (HbA1c < 7.5% [<58 mmol/mol] n = 81, 7.5-8.9% [58-74 mmol/mol] n = 70, >8.9% [>74 mmol/mol] n = 63). Baseline characteristics, including use of potential hypoglycaemic drugs, were similar between groups. During the 8 years of follow-up 151 patients died (70.6%) and HbA1c < 7.5% (<58 mmol/mol) was strongly associated with increased mortality. The highest mortality was seen in patients with a combination of HbA1c < 7.5% (<58 mmol/mol) and QTc prolongation, with an 8 year mortality of 92.1% as compared with 48.8% in those with HbA1c < 7.5% (<58 mmol/mol) but without QTc prolongation. CONCLUSION/INTERPRETATIONS: HbA1c < 7.5% (<58 mmol/mol) in a high-risk population of patients with type 2 diabetes and foot ulcers is associated with a significantly higher mortality, particularly in patients with QTc prolongation.
目的/假设：慢性糖尿病足溃疡患者的全因死亡率不能完全用传统心血管危险因素来解释。这些患者中经常出现的心率校正 QT（QTc）延长的意义尚不清楚。最近，代谢控制和低血糖的重要性受到了讨论。本研究的目的是评估不同 HbA1c 水平和 QTc 延长对 2 型糖尿病伴足部溃疡高危人群全因死亡率的影响。
所有年龄小于 80 岁、患有 2 型糖尿病、足部溃疡持续时间超过 4 周、正在我院糖尿病足科就诊的患者均接受参与筛选。排除正在接受透析的患者。根据 HbA1c 水平和 QTc 时间≤或>440ms 将患者分组。
共纳入 214 名患者（中位年龄 69.1 岁），根据 HbA1c 水平分组（HbA1c<7.5% [<58mmol/mol] 81 例，7.5-8.9% [58-74mmol/mol] 70 例，>8.9% [>74mmol/mol] 63 例）。各组间的基线特征，包括潜在低血糖药物的使用情况，均相似。在 8 年的随访期间，有 151 名患者死亡（70.6%），HbA1c<7.5%（<58mmol/mol）与死亡率增加显著相关。HbA1c<7.5%（<58mmol/mol）且 QTc 延长的患者死亡率最高，8 年死亡率为 92.1%，而 HbA1c<7.5%（<58mmol/mol）但无 QTc 延长的患者死亡率为 48.8%。
结论/解释：2 型糖尿病伴足部溃疡高危人群中 HbA1c<7.5%（<58mmol/mol）与死亡率显著增加相关，尤其是伴有 QTc 延长的患者。
