Deconinck Barbara, Mathieu Chantal, Benhalima Katrien
Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Diabetol Metab Syndr. 2017 May 2;9:28. doi: 10.1186/s13098-017-0227-z. eCollection 2017.
The aim was to evaluate the characteristics and cardiovascular complications of a large Belgian cohort of adults diagnosed with type 2 diabetes (T2DM) <45 years.
Retrospective analysis of 886 patients diagnosed with T2DM <45 years and 933 T2DM patients diagnosed at the age between 60 and 70 years. To compare variables between groups, the independent test or paired test was used for normally distributed continuous variables, the Mann-Whitney's -test for non-normally distributed continuous variables and the Chi squared test or McNemar test for categorical variables. Multivariable logistic regression was used to adjust for confounders.
In the young-onset T2DM cohort, the age at diagnosis was 37.3 ± 6.4 years, 44.1% of patients were female and 12.1% were from an ethnic minority (EM) background. At last visit, age of patients was 57.3 ± 12.5 years with a diabetes duration of 20.5 ± 11.8 years and a mean HbA1c of 7.3% ± 1.3 (56 mmol/mol ± 14). Of all patients, 56.8% were obese, 49.9% were hypertensive, 34.1% did not reach the LDL cholesterol target and 20.1% had a cardiac event by time of last visit. Compared to women, men had a higher HbA1c [7.3% ± 1.4 (56 mmol/mol ± 15) vs. 7.1% ± 1.2 (54 mmol/mol ± 13), p = 0.021] and a significantly higher rate of cardiac events, even after adjustment for confounders (24.3 vs. 14.8%, p = 0.010). Compared to Caucasians, EM patients were younger at diagnosis (35.4 ± 6.8 years vs. 37.6 ± 6.2 years, p = 0.001) and were less often obese (43.3 vs. 55.6%, p = 0.007). Compared to the first visit, glycemic control improved [7.3% ± 1.3 (56 mmol/mol ± 14) vs. 7.9% ± 1.7 (62 mmol/mol ± 19), p < 0.0001] by the time of the last visit. Compared to the older-onset T2DM cohort, young-onset T2DM patients showed a higher HbA1c [7.3 ± 1.3% (56 mmol/mol ± 14) vs. 6.9 ± 1.0% (51 mmol/mol ± 11), p = <0.0001] and a higher BMI (31.2 ± 5.8 vs. 29.6 ± 5.5 kg/m, p = <0.0001) at last contact. When adjusted for age, diabetes duration, HbA1c and cardiovascular risk factors, there was no difference in cardiovascular events between the two cohorts.
A diagnosis of T2DM <45 years has an important impact on patients' lives. Prevention measures are essential, but also specific attention to this high-risk group is needed for them to better achieve their therapeutic targets.
目的是评估比利时一个大型成年队列中45岁以下被诊断为2型糖尿病（T2DM）患者的特征及心血管并发症。
对886例45岁以下被诊断为T2DM的患者和933例60至70岁被诊断为T2DM的患者进行回顾性分析。为比较组间变量，对于正态分布的连续变量使用独立t检验或配对t检验，对于非正态分布的连续变量使用曼-惠特尼U检验，对于分类变量使用卡方检验或 McNemar 检验。采用多变量逻辑回归调整混杂因素。
在早发T2DM队列中，诊断时年龄为37.3±6.4岁，44.1%的患者为女性，12.1%来自少数民族（EM）背景。在最后一次随访时，患者年龄为57.3±12.5岁，糖尿病病程为20.5±11.8年，平均糖化血红蛋白（HbA1c）为7.3%±1.3（56 mmol/mol±14）。所有患者中，56.8%肥胖，49.9%高血压，34.1%未达到低密度脂蛋白胆固醇目标，20.1%在最后一次随访时有心脏事件。与女性相比，男性的HbA1c更高[7.3%±1.4（56 mmol/mol±15）对7.1%±1.2（54 mmol/mol±13），p = 0.021]，即使在调整混杂因素后心脏事件发生率也显著更高（24.3%对14.8%，p = 0.010）。与白种人相比，EM患者诊断时更年轻（35.4±6.8岁对37.6±6.2岁，p = 0.001），肥胖的比例更低（43.3%对55.6%，p = 0.007）。与首次就诊时相比，最后一次随访时血糖控制有所改善[7.3%±1.3（56 mmol/mol±14）对7.9%±1.7（62 mmol/mol±19），p < 0.0001]。与晚发T2DM队列相比，早发T2DM患者在最后一次接触时HbA1c更高[7.3±1.3%（56 mmol/mol±14）对6.9±1.0%（51 mmol/mol±11），p = <0.0001]，体重指数（BMI）更高（31.2±5.8对29.6±5.5 kg/m²，p = <0.0001）。在调整年龄、糖尿病病程、HbA1c和心血管危险因素后，两个队列的心血管事件无差异。
45岁以下诊断为T2DM对患者生活有重要影响。预防措施至关重要，但也需要特别关注这个高危群体，以便他们更好地实现治疗目标。
