Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Cardiology, St. Olavs Hospital, Trondheim, Norway.
J Intern Med. 2016 Nov;280(5):518-531. doi: 10.1111/joim.12530. Epub 2016 Jul 22.
The long-term consequences of autoimmune diabetes in adults (AIDA) are largely unexplored.
To investigate the risk of myocardial infarction (MI) in AIDA compared to type 2 diabetes, taking into consideration the effects of socio-economic and lifestyle factors, the metabolic syndrome and glycaemic control.
A total of 62 995 participants including 207 individuals with AIDA (onset ≥35 years and anti-GAD positive) and 2322 individuals with type 2 diabetes (onset ≥35 years and anti-GAD negative), from the population-based Norwegian HUNT study, were followed for a first MI during the period 1995-2008. We identified 2614 MIs by hospital records or the National Cause of Death Registry. Cox proportional hazard models were used to estimate the risk of MI by diabetes subgroups after adjustment for age and socio-economic and lifestyle factors.
AIDA amongst women was associated with a nearly fourfold increased risk of MI [hazard ratio (HR) 3.63, 95% confidence interval (CI) 2.21-5.96) compared to nondiabetic participants, whereas no excess risk was found in men with AIDA (HR 1.30, 95% CI 0.70-2.52). By contrast, type 2 diabetes was associated with an increased MI risk in both men (HR 1.92, 95% CI 1.62-2.26) and women (HR 2.39, 95% CI 1.98-2.89). The metabolic profile was more favourable in patients with AIDA than in those with type 2 diabetes, but glycaemic control was worse. Multivariable models and sensitivity analyses suggest that these results were robust.
Women with AIDA were more likely to develop MI, compared to men with AIDA and both men and women with type 2 diabetes. Further investigations are warranted to confirm this gender difference.
成人自身免疫性糖尿病（AIDA）的长期后果在很大程度上尚未得到探索。
研究与 2 型糖尿病相比，AIDA 患者发生心肌梗死（MI）的风险，同时考虑社会经济和生活方式因素、代谢综合征和血糖控制的影响。
共纳入 62995 名参与者，包括 207 名 AIDA 患者（发病年龄≥35 岁且抗 GAD 阳性）和 2322 名 2 型糖尿病患者（发病年龄≥35 岁且抗 GAD 阴性），均来自基于人群的挪威 HUNT 研究。在 1995 年至 2008 年期间，我们通过医院记录或国家死因登记处确定了 2614 例 MI。使用 Cox 比例风险模型，在调整年龄以及社会经济和生活方式因素后，按糖尿病亚组估计 MI 的发病风险。
与非糖尿病参与者相比，女性 AIDA 患者发生 MI 的风险几乎增加了四倍（危险比 [HR]3.63，95%置信区间 [CI]2.21-5.96），而男性 AIDA 患者则没有发生 MI 的风险增加（HR1.30，95%CI0.70-2.52）。相比之下，2 型糖尿病与男性（HR1.92，95%CI1.62-2.26）和女性（HR2.39，95%CI1.98-2.89）发生 MI 的风险增加相关。与 2 型糖尿病患者相比，AIDA 患者的代谢特征更有利，但血糖控制更差。多变量模型和敏感性分析表明，这些结果是可靠的。
与男性 AIDA 患者和男性及女性 2 型糖尿病患者相比，女性 AIDA 患者更易发生 MI。需要进一步的研究来证实这种性别差异。
