Hadi Alijanvand Moluk, Aminorroaya Ashraf, Kazemi Iraj, Aminorroaya Yamini Sima, Janghorbani Mohsen, Amini Masoud, Mansourian Marjan
Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
Isfahan Endocrine and Metabolism Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
Diabetes Metab Syndr Obes. 2019 Jul 15;12:1123-1139. doi: 10.2147/DMSO.S189726. eCollection 2019.
Moderately increased albuminuria (MIA) is strongly associated with hypertension (HTN) in patients with type 2 diabetic mellitus (T2DM). However, the association between risk factors and coexisting HTN and MIA remains unassessed.
This study aimed to determine both cross-sectional and longitudinal associations of risk factors with HTN and MIA comorbidity in patients with T2DM.
A total of 1,600 patients with T2DM were examined at baseline and longitudinal data were obtained from 1,337 T2DM patients with at least 2 follow-up visits to assess the presence of HTN alone (yes/no), MIA alone (yes/no) and the coexistence of both (yes/no) in a 9-year open cohort study between 2004 and 2013. Bivariate mixed-effects logistic regression with a Bayesian approach was employed to evaluate associations of risk factors with HTN and MIA comorbidity in the longitudinal assessment.
After adjustment for age and BMI, patients with uncontrolled plasma glucose, as a combined index of the glucose profile, were more likely to have HTN [odds ratio (OR): 1.73 with 95% Bayesian credible intervals (BCI) 1.29-2.20] and MIA [OR: 1.34 (95% BCI 1.13-1.62)]. The risks of having HTN and MIA were increased by a one-year raise in diabetes duration [with 0.89 (95% BCI 0.84-0.96) and 0.81 (95% BCI 0.73-0.92) ORs, respectively] and a one-unit increase in non-high-density lipoprotein-cholesterol (Non-HDL-C) [with 1.30 (95% BCI 1.23-1.34) and 1.24 (95% BCI 1.14-1.33) ORs, respectively].
T2DM patients with HTN, MIA, and the coexistence of both had uncontrolled plasma glucose, significantly higher Non-HDL-C, and shorter diabetes duration than the other T2DM patients. Duration of diabetes and uncontrolled plasma glucose index showed the stronger effects on HTN and MIA comorbidity than on each condition separately.
在2型糖尿病（T2DM）患者中，中度蛋白尿增加（MIA）与高血压（HTN）密切相关。然而，风险因素与并存的HTN和MIA之间的关联仍未得到评估。
本研究旨在确定T2DM患者中风险因素与HTN和MIA合并症的横断面和纵向关联。
在一项2004年至2013年的9年开放队列研究中，共对1600例T2DM患者进行了基线检查，并从1337例至少有2次随访的T2DM患者中获取纵向数据，以评估单独存在HTN（是/否）、单独存在MIA（是/否）以及两者并存（是/否）的情况。采用贝叶斯方法的双变量混合效应逻辑回归来评估纵向评估中风险因素与HTN和MIA合并症的关联。
在调整年龄和体重指数后，作为血糖谱综合指标的血糖控制不佳的患者更有可能患HTN [比值比（OR）：1.73，95%贝叶斯可信区间（BCI）为1.29 - 2.20]和MIA [OR：1.34（95% BCI 1.13 - 1.62）]。糖尿病病程每增加一年，患HTN和MIA的风险分别增加[OR分别为0.89（95% BCI 0.84 - 0.96）和0.81（95% BCI 0.73 - 0.92）]，非高密度脂蛋白胆固醇（Non-HDL-C）每增加一个单位，患HTN和MIA的风险分别增加[OR分别为1.30（95% BCI 1.23 - 1.34）和1.24（95% BCI 1.14 - 1.33）]。
与其他T2DM患者相比，患有HTN、MIA以及两者并存的T2DM患者血糖控制不佳、Non-HDL-C显著更高且糖尿病病程更短。糖尿病病程和血糖控制不佳指数对HTN和MIA合并症的影响比对每种情况单独影响更强。
