CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Diabet Med. 2020 Sep;37(9):1519-1527. doi: 10.1111/dme.14298. Epub 2020 Apr 3.
To determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA criteria, is associated with mortality in a 10-year cohort of people in a Latin American country.
Analysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural-to-urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow-up assessment in 2018. The outcome was all-cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6-6.9 mmol/l (100-125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA levels 39-46 mmol/mol (5.7-6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA levels 42-46 mmol/mol (6.0-6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models.
At baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural-to-urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA -based definition and the American Diabetes Association HbA -based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all-cause mortality using the HbA -based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59-4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62-5.28) according to the International Expert Committee], whereas American Diabetes Association-defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26-2.68)]. In the adjusted model, however, only the American Diabetes Association HbA -based definition was associated with all-cause mortality [hazard ratio 1.91 (95% CI 1.03-3.53)], whereas the International Expert Committee HbA -based and American Diabetes Association impaired fasting glucose-based definitions were not [hazard ratios 1.42 (95% CI 0.75-2.68) and 1.09 (95% CI 0.33-3.63), respectively].
Intermediate hyperglycaemia defined using the American Diabetes Association HbA criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA appears to be a factor associated with mortality in this Peruvian population.
在一个拉丁美洲国家的 10 年队列中，确定空腹血糖和 HbA 标准定义的中间高血糖是否与死亡率相关。
对 PERU MIGRANT 研究进行了分析，该研究在三个不同的人群组（农村、农村到城市移民和城市）中进行。基线评估于 2007/2008 年进行，随访评估于 2018 年进行。结局是全因死亡率，暴露是中间高血糖，使用三种定义：（1）根据美国糖尿病协会标准定义的受损空腹血糖[空腹血糖 5.6-6.9 mmol/l（100-125 mg/dl）]；（2）根据美国糖尿病协会标准定义的中间高血糖[HbA 水平 39-46 mmol/mol（5.7-6.4%）]；和（3）根据国际专家委员会标准定义的中间高血糖[HbA 水平 42-46 mmol/mol（6.0-6.4%）]。使用 Cox 比例风险模型估计了粗和调整后的风险比和 95%CI。
在基线时，研究人群的平均（标准差）年龄为 47.8（11.9）岁，52.5%的队列为女性。研究队列分为以下人群组：农村人群组 207 人（20.0%），农村到城市移民人群组 583 人（59.7%）和城市人群组 198 人（20.3%）。中间高血糖的患病率分别为：根据美国糖尿病协会受损空腹血糖定义为 6%，根据国际专家委员会 HbA 定义为 12.9%，根据美国糖尿病协会 HbA 定义为 38.5%，10 年后的死亡率为 63/976（7%）。中间高血糖与全因死亡率相关，在未经调整的模型中，根据 HbA 定义的模型中使用了基于 HbA 的定义[根据美国糖尿病协会的危险比为 2.82（95%CI 1.59-4.99），根据国际专家委员会为 2.92（95%CI 1.62-5.28）]，而美国糖尿病协会定义的受损空腹血糖没有[危险比 0.84（95%CI 0.26-2.68）]。然而，在调整后的模型中，只有美国糖尿病协会的 HbA 定义与全因死亡率相关[危险比 1.91（95%CI 1.03-3.53）]，而国际专家委员会的 HbA 定义和美国糖尿病协会受损空腹血糖定义则没有[危险比 1.42（95%CI 0.75-2.68）和 1.09（95%CI 0.33-3.63）]。
在秘鲁的一个队列中，使用美国糖尿病协会 HbA 标准定义的中间高血糖与 10 年后的死亡率升高有关。HbA 似乎是该秘鲁人群死亡的一个相关因素。
