Chan Juliana C N, Lau Eric S H, Luk Andrea O Y, Cheung Kitty K T, Kong Alice P S, Yu Linda W L, Choi Kai-Chow, Chow Francis C C, Ozaki Risa, Brown Nicola, Yang Xilin, Bennett Peter H, Ma Ronald C W, So Wing-Yee
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; Hong Kong Institute of Diabetes and Obesity, Hong Kong; Li Ka Shing Institute of Health Sciences, Hong Kong.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Am J Med. 2014 Jul;127(7):616-24. doi: 10.1016/j.amjmed.2014.03.018. Epub 2014 Mar 25.
There is an increasing prevalence of young-onset diabetes, especially in developing areas. We compared the clinical outcomes and predictors for cardiovascular-renal events between Chinese patients with type 2 diabetes with young- or late-onset of disease diagnosed before or after the age of 40 years, respectively.
The Hong Kong Diabetes Registry was established in 1995 as an ongoing quality improvement initiative with consecutive enrollment of diabetic patients from ambulatory settings for documentation of risk factors, microvascular and macrovascular complications, and clinical outcomes using a structured protocol.
In 9509 Chinese patients with type 2 diabetes with a median (interquartile range) follow-up period of 7.5 (3.9-10.8) years, 21.3% (n = 2066) had young-onset diabetes. Despite 20 years difference in age, patients with young-onset diabetes (mean age, 41.3 years) had a similar or worse risk profile than those with late-onset disease (mean age, 61.9 years). Compared with the patients with late-onset diabetes, those with young-onset diabetes had lower rates of cardiovascular disease and chronic kidney disease for the same disease duration but a higher cumulative incidence of clinical events at any given age. With the use of stepwise Cox proportional hazard analysis, patients with young-onset diabetes had higher risks for cardiovascular and renal events when adjusted by age, but no difference in risks than in the patients with late-onset diabetes when further adjusted by disease duration.
Patients with young-onset diabetes had a similar or worse metabolic risk profile compared with those with late-onset disease. This group had higher risks for cardiovascular-renal complications at any given age, driven by longer disease duration.
青年发病型糖尿病的患病率正在上升，尤其是在发展中地区。我们比较了分别在40岁之前或之后诊断为2型糖尿病的中国青年发病型和晚发型患者心血管肾脏事件的临床结局及预测因素。
香港糖尿病登记处成立于1995年，是一项持续的质量改进计划，连续纳入门诊糖尿病患者，使用结构化方案记录危险因素、微血管和大血管并发症以及临床结局。
在9509例2型糖尿病中国患者中，中位（四分位间距）随访期为7.5（3.9 - 10.8）年，21.3%（n = 2066）患有青年发病型糖尿病。尽管年龄相差20岁，但青年发病型糖尿病患者（平均年龄41.3岁）的风险状况与晚发型患者（平均年龄61.9岁）相似或更差。与晚发型糖尿病患者相比，青年发病型糖尿病患者在相同病程时心血管疾病和慢性肾脏病的发生率较低，但在任何给定年龄临床事件的累积发生率较高。通过逐步Cox比例风险分析，青年发病型糖尿病患者在按年龄调整后发生心血管和肾脏事件的风险较高，但在进一步按病程调整后，与晚发型糖尿病患者的风险无差异。
青年发病型糖尿病患者的代谢风险状况与晚发型患者相似或更差。由于病程较长，该组在任何给定年龄发生心血管肾脏并发症的风险较高。
