Anjana Ranjit Mohan, Shanthirani Coimbatore Subramanian, Unnikrishnan Ranjit, Mugilan Poongkunran, Amutha Anandakumar, Nair Haridas Divya, Subhashini Sivasankaran, Venkatesan Ulagamathesan, Ali Mohammed K, Ranjani Harish, Mohan Viswanathan
Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control & IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India,
Acta Diabetol. 2015 Jun;52(3):601-9. doi: 10.1007/s00592-014-0701-0. Epub 2014 Dec 25.
To assess the relationship between regularity of follow-up and risk of complications in patients with type 2 diabetes (T2DM) followed up for 9 years at a tertiary diabetes center in India.
We compared glycemic burden [cumulative time spent above a HbA1c of 53 mmol/mol (7 %)] and incidence of diabetes complications (retinopathy, neuropathy, nephropathy, peripheral arterial disease, coronary heart disease) between 1,783 T2DM patients with "regular follow-up" (minimum of three visits and two HbA1c tests every year from 2003 to 2012), and 1,798 patients with "irregular follow-up" (two visits or less and one HbA1c or less per year during the same time period), retrospectively identified from medical records. Cox proportional hazards models were used to estimate risk associated with diabetes complications.
Compared to those with regular follow-up, the irregular follow-up group had significantly higher mean fasting and postprandial plasma glucose, HbA1c, glycemic burden, total and LDL cholesterol, and triglycerides at every time point during the 9 years of follow-up. Those with irregular follow-up had double the total and mean monthly glycemic burden and 1.98 times higher risk of retinopathy (95 % CI 1.62, 2.42) and 2.11 times higher risk of nephropathy (95 % CI 1.73, 2.58) compared to those with regular follow-up, even after adjusting for time-varying confounding variables. Complications tended to develop significantly earlier and were more severe in those with irregular follow-up.
Among patients with type 2 diabetes, regular follow-up was associated with significantly lower glycemic burden and lower incidence of retinopathy and nephropathy over a 9-year period.
评估在印度一家三级糖尿病中心接受9年随访的2型糖尿病（T2DM）患者的随访规律与并发症风险之间的关系。
我们比较了1783例“定期随访”（2003年至2012年期间每年至少就诊3次且进行2次糖化血红蛋白检测）的T2DM患者和1798例“不定期随访”（同一时期每年就诊2次或更少且糖化血红蛋白检测1次或更少）患者的血糖负担[糖化血红蛋白高于53 mmol/mol（7%）的累计时间]以及糖尿病并发症（视网膜病变、神经病变、肾病、外周动脉疾病、冠心病）发生率，这些数据是从医疗记录中回顾性获取的。采用Cox比例风险模型来估计与糖尿病并发症相关的风险。
与定期随访的患者相比，不定期随访组在9年随访期间的每个时间点，空腹和餐后血浆葡萄糖、糖化血红蛋白、血糖负担、总胆固醇和低密度脂蛋白胆固醇以及甘油三酯的均值均显著更高。即使在调整了随时间变化的混杂变量后，不定期随访的患者总血糖负担和每月平均血糖负担是定期随访患者的两倍，视网膜病变风险高1.98倍（95%置信区间1.62, 2.42），肾病风险高2.11倍（95%置信区间1.73, 2.58）。并发症在不定期随访的患者中往往显著更早出现且更严重。
在2型糖尿病患者中，定期随访与9年期间显著更低的血糖负担以及更低的视网膜病变和肾病发生率相关。
