Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.
Ann Acad Med Singap. 2019 Jul;48(7):217-223.
The risk for diabetes progression varies greatly in individuals with type 2 diabetes mellitus (T2DM). We aimed to study the clinical determinants of diabetes progression in multiethnic Asians with T2DM.
A total of 2057 outpatients with T2DM from a secondary-level Singapore hospital were recruited for the study. Diabetes progression was defined as transition from non-insulin use to requiring sustained insulin treatment or glycated haemoglobin (HbA1c) ≥8.5% when treated with 2 or more oral hypoglycaemic medications. Multivariable logistic regression (LR) was used to study the clinical and biochemical variables that were independently associated with diabetes progression. Forward LR was then used to select variables for a parsimonious model.
A total of 940 participants with no insulin use or indication for insulin treatment were analysed. In 3.2 ± 0.4 (mean ± SD) years' follow-up, 163 (17%) participants experienced diabetes progression. Multivariable LR revealed that age at T2DM diagnosis (odds ratio [95% confidence interval], 0.96 [0.94-0.98]), Malay ethnicity (1.94 [1.19-3.19]), baseline HbA1c (2.22 [1.80-2.72]), body mass index (0.96 [0.92-1.00]) and number of oral glucose-lowering medications (1.87 [1.39-2.51]) were independently associated with diabetes progression. Area under receiver operating characteristic curve of the parsimonious model selected by forward LR (age at T2DM diagnosis, Malay ethnicity, HbA1c and number of glucose-lowering medication) was 0.76 (95% CI, 0.72-0.80).
Young age at T2DM diagnosis, high baseline HbA1c and Malay ethnicity are independent determinants of diabetes progression in Asians with T2DM. Further mechanistic studies are needed to elucidate the pathophysiology underpinning progressive loss of glycaemic control in patients with T2DM.
2 型糖尿病（T2DM）患者的糖尿病进展风险差异很大。我们旨在研究亚洲多种族人群中 T2DM 患者糖尿病进展的临床决定因素。
从新加坡一家二级医院招募了 2057 名 T2DM 门诊患者进行研究。糖尿病进展定义为从不使用胰岛素转变为需要持续胰岛素治疗，或在使用 2 种或更多口服降糖药物治疗时糖化血红蛋白（HbA1c）≥8.5%。多变量逻辑回归（LR）用于研究与糖尿病进展独立相关的临床和生化变量。然后使用向前 LR 为简化模型选择变量。
共分析了 940 名无胰岛素使用或胰岛素治疗指征的参与者。在 3.2±0.4（平均±标准差）年的随访中，163 名（17%）参与者发生了糖尿病进展。多变量 LR 显示，T2DM 诊断时的年龄（比值比[95%置信区间]，0.96[0.94-0.98]）、马来族裔（1.94[1.19-3.19]）、基线 HbA1c（2.22[1.80-2.72]）、体重指数（0.96[0.92-1.00]）和口服降血糖药物的数量（1.87[1.39-2.51]）与糖尿病进展独立相关。向前 LR 选择的简化模型的受试者工作特征曲线下面积（T2DM 诊断时的年龄、马来族裔、HbA1c 和降血糖药物的数量）为 0.76（95%CI，0.72-0.80）。
T2DM 诊断时年龄较小、基线 HbA1c 较高和马来族裔是亚洲 T2DM 患者糖尿病进展的独立决定因素。需要进一步的机制研究来阐明 T2DM 患者血糖控制逐渐丧失的病理生理学机制。
