Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan; School of Medicine, National Defence Medical Centre, Taipei, Taiwan.
Diabetes Metab. 2018 Mar;44(2):121-128. doi: 10.1016/j.diabet.2017.09.001. Epub 2017 Oct 9.
To investigate the effect of changes in fasting plasma glucose (FPG) variability, as assessed by 2-year trajectories of FPG variability, on mortality risk in patients with type 2 diabetes (T2D).
From 2009 to 2012, outpatients with T2D, aged>18 years, were enrolled from a medical centre. FPG was measured every 3 months for 2 years in 3569 people. For each of the eight 3-month intervals, FPG variability and means were calculated, with variability defined as the coefficient of variation of FPG. Also, trajectories of FPG variability and means were determined separately, using group-based trajectory analysis with latent class growth models. These models were fitted using the SAS Proc Traj procedure. The primary outcome was all-cause mortality, which was followed-up to the end of 2014.
Five distinct trajectories of FPG variability (low, increasing, fluctuating, decreasing and high) and means (well controlled, stable control, worsening control, improving control and poor control) were established. The five trajectories of mean FPG were all associated with the same mortality risk. In contrast, in comparison to the low FPG variability trajectory, the fluctuating, decreasing and high variability trajectories all had significantly higher risks of mortality, with respective hazards ratios of 2.63 (95% CI: 1.40-4.93; P=0.003), 2.78 (95% CI: 1.33-5.80; P=0.007) and 4.44 (95% CI: 1.78-11.06; P=0.001) after multivariable adjustment.
Changes in FPG variability were independently associated with increased mortality risk in patients with T2D.
通过评估 2 年 FPG 变异性轨迹，研究空腹血糖（FPG）变异性变化对 2 型糖尿病（T2D）患者死亡风险的影响。
2009 年至 2012 年，从一家医疗中心招募了年龄>18 岁的 T2D 门诊患者。3569 人在 2 年内每 3 个月测量一次 FPG。对于每 3 个月的 8 个间隔，计算 FPG 变异性和平均值，FPG 变异性定义为 FPG 的变异系数。此外，还分别使用基于群组的轨迹分析和潜在类别增长模型来确定 FPG 变异性和平均值的轨迹。这些模型使用 SAS Proc Traj 程序进行拟合。主要结局是全因死亡率，随访至 2014 年底。
确定了 5 种不同的 FPG 变异性（低、增加、波动、减少和高）和平均值（控制良好、稳定控制、控制恶化、控制改善和控制不良）轨迹。平均 FPG 的这 5 种轨迹均与相同的死亡风险相关。相比之下，与低 FPG 变异性轨迹相比，波动、减少和高变异性轨迹的死亡风险均显著增加，其相应的危险比分别为 2.63（95%CI：1.40-4.93；P=0.003）、2.78（95%CI：1.33-5.80；P=0.007）和 4.44（95%CI：1.78-11.06；P=0.001），在多变量调整后。
FPG 变异性的变化与 T2D 患者死亡风险的增加独立相关。
