Orsi Emanuela, Bonora Enzo, Solini Anna, Fondelli Cecilia, Trevisan Roberto, Vedovato Monica, Cavalot Franco, Zerbini Gianpaolo, Morano Susanna, Nicolucci Antonio, Penno Giuseppe, Pugliese Giuseppe
Diabetes Unit, Fondazione IRCCS "Cà Granda-Ospedale Maggiore Policlinico", 20122 Milan, Italy.
Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, 37126 Verona, Italy.
J Clin Med. 2020 Jan 17;9(1):246. doi: 10.3390/jcm9010246.
The increased mortality reported with intensive glycaemic control has been attributed to an increased risk of treatment-related hypoglycaemia. This study investigated the relationships of haemoglobin (Hb) A, anti-hyperglycaemic treatment, and potential risks of adverse effects with all-cause mortality in patients with type 2 diabetes. Patients ( = 15,773) were stratified into four categories according to baseline HbA and then assigned to three target categories, based on whether HbA was ≤0.5% below or above (on-target), >0.5% below (below-target) or >0.5% above (above-target) their HbA goal, personalized according to the number of potential risks among age > 70 years, diabetes duration > 10 years, advanced complication(s), and severe comorbidity (ies). The vital status was retrieved for 15,656 patients (99.26%). Over a 7.4-year follow-up, mortality risk was increased among patients in the highest HbA category (≥8.5%) (adjusted hazard ratio, 1.34 (95% confidence interval, 1.22-1.47), < 0.001) and those above-target (1.42 (1.29-1.57), < 0.001). Risk was increased among individuals in the lowest HbA category (<6.5%) and those below-target only if treated with agents causing hypoglycaemia (1.16 (1.03-1.29), = 0.01 and 1.10 (1.01-1.22), = 0.04, respectively). These data suggest the importance of setting both upper and lower personalized HbA goals to avoid overtreatment in high-risk individuals with type 2 diabetes treated with agents causing hypoglycaemia.
强化血糖控制导致死亡率升高被归因于治疗相关低血糖风险增加。本研究调查了2型糖尿病患者血红蛋白（Hb）A、降糖治疗及不良反应潜在风险与全因死亡率之间的关系。根据基线HbA将患者（n = 15773）分为四类，然后根据HbA相对于其HbA目标是低于目标值0.5%或以上（达标）、低于目标值>0.5%（未达标）或高于目标值>0.5%（超达标），并根据年龄>70岁、糖尿病病程>10年、存在晚期并发症和严重合并症等潜在风险数量进行个体化分层，分为三个目标类别。对15656例患者（99.26%）进行了生命状态检索。在7.4年的随访中，HbA最高类别（≥8.5%）的患者（调整后风险比，1.34（95%置信区间，1.22 - 1.47），P < 0.001）和超达标的患者（1.42（1.29 - 1.57），P < 0.001）的死亡风险增加。HbA最低类别（<6.5%）的个体以及仅在使用导致低血糖的药物治疗时未达标的个体的风险增加（分别为1.16（1.03 - 1.29），P = 0.01和1.10（1.01 - 1.22），P = 0.04）。这些数据表明，对于使用导致低血糖药物治疗的2型糖尿病高危个体，设定个性化HbA目标的上限和下限以避免过度治疗非常重要。
