University of Otago, Wellington, New Zealand.
University of Auckland, Waikato District Health Board, New Zealand.
Diabetes Res Clin Pract. 2019 Feb;148:119-129. doi: 10.1016/j.diabres.2018.12.003. Epub 2019 Jan 8.
To examine the incidence of type 2 diabetes in people with newly diagnosed prediabetes and the factors that protect against this progression.
The study population was 14,043 adults with pre-diabetes enrolled in a primary health organization in the upper North Island of New Zealand. Glycated hemoglobin (HbA1c) and body mass index (BMI) were linked to government health, census and social datasets in the Statistics New Zealand Integrated Data Infrastructure. Adults with a first diagnosis of pre-diabetes between 2009 and 2017 (HbA1c in range 5.9-6.6% [41-49 mmol/mol]) were followed-up for type 2 diabetes incidence. Cox regression was used to examine protective factors and adjust for potential confounding.
Cumulative diabetes incidence was 5.0% after three years. Progression was greater in younger adults, men, people with higher HbA1c, greater BMI and a more recent diagnosis. Progression was lower in people treated with metformin, and Indigenous language speakers. Higher progression rates for Māori (Indigenous population) and Pacific peoples (migrants to New Zealand) were related to higher baseline HbA1c.
This is the first study to identify Indigenous language as a protective factor against diabetes, and results confirm obesity as a key target for population prevention. People with identified risk factors should be prioritized for pre-diabetes interventions.
研究新诊断的糖尿病前期患者中 2 型糖尿病的发病率，以及预防这种进展的相关因素。
研究人群为新西兰北岛北部一个初级卫生组织中 14043 名患有前期糖尿病的成年人。糖化血红蛋白（HbA1c）和体重指数（BMI）与新西兰统计局综合数据基础设施中的政府健康、人口普查和社会数据集相关联。2009 年至 2017 年间首次诊断为前期糖尿病（HbA1c 在 5.9-6.6%[41-49mmol/mol]范围内）的成年人被追踪观察 2 型糖尿病的发病率。使用 Cox 回归来检验保护因素，并调整潜在的混杂因素。
三年后，累积糖尿病发病率为 5.0%。在年轻人、男性、HbA1c 更高、BMI 更高、最近诊断的患者中，病情进展更大。在接受二甲双胍治疗的患者和讲原住民族语言的患者中，病情进展较慢。毛利人（原住民）和太平洋岛民（新西兰移民）的较高进展率与较高的基线 HbA1c 有关。
这是第一项确定原住民族语言是预防糖尿病的保护因素的研究，研究结果证实肥胖是人群预防的关键目标。应优先考虑具有已识别风险因素的患者进行前期糖尿病干预。
