Aliyari Roqayeh, Hajizadeh Ebrahim, Aminorroaya Ashraf, Sharifi Farshad, Kazemi Iraj, Baghestani Ahmad-Reza
Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Diabetes Metab Syndr Obes. 2020 May 28;13:1863-1872. doi: 10.2147/DMSO.S234563. eCollection 2020.
Increase in the prevalence of type 2 diabetic mellitus (T2DM) as a complex disease, its complications, and spread has become a dominant global health threat in recent decades.
The aim of the current study was to investigate the impact of risk factors and transition probability on the development and progression of the late complications of T2DM.
This study was an open cohort one which was conducted at Isfahan Endocrine and Metabolism Research Center (IEMRC). The data were collected from 1993 to 2018. The sample size consisted of 2519 adults diagnosed with type 2 diabetes. We applied the homogeneous multistate models including no complication, retinopathy alone, coronary artery disease (CAD), microalbuminuria, retinopathy and CAD, and the final absorbing mortality states.
Based on our results, time-varying hypertension strongly intensified the hazard of transition to mortality in CAD, no complication, CAD and retinopathy, and retinopathy patients by 4.99, 4.09, 3.42, and 2.65 times, respectively. Hypertension seemed to be a potential factor for the transition of microalbuminuria to no complication in diabetic patients. One-unit increase in LDL increased the hazard ratio of transition from CAD, and retinopathy and CAD to mortality by 1.8% and 2.4%, respectively. Moreover, one level increase in time-varying HbA1c increased the hazard ratio of transition to retinopathy and mortality among no complication diabetic patients by 30% and 67%, respectively. One level increase in time-varying HbA1c also intensified the hazard ratio of transition from retinopathy to mortality by 45%. The same level of increase in time-varying HbA1c also intensified the hazard ratio of transition from CAD alone to CAD and retinopathy, and microalbuminuria to retinopathy by 26% and 50%, respectively.
In addition to glycemic control, our study indicates that controlling hypertension and hyperlipidemia is more effective in reducing mortality and the diabetic macro- and microvascular complications.
近几十年来，2型糖尿病（T2DM）作为一种复杂疾病，其患病率、并发症及传播范围的增加已成为全球主要的健康威胁。
本研究旨在探讨危险因素和转移概率对T2DM晚期并发症发生和发展的影响。
本研究是一项在伊斯法罕内分泌与代谢研究中心（IEMRC）开展的开放队列研究。数据收集时间为1993年至2018年。样本量包括2519名被诊断为2型糖尿病的成年人。我们应用了同质多状态模型，包括无并发症、单纯视网膜病变、冠状动脉疾病（CAD）、微量白蛋白尿、视网膜病变和CAD，以及最终的吸收性死亡状态。
根据我们的研究结果，随时间变化的高血压分别使CAD、无并发症、CAD和视网膜病变以及视网膜病变患者向死亡转移的风险显著增加4.99倍、4.09倍、3.42倍和2.65倍。高血压似乎是糖尿病患者微量白蛋白尿向无并发症转变的一个潜在因素。低密度脂蛋白（LDL）每增加一个单位，从CAD以及视网膜病变和CAD向死亡转移的风险比分别增加1.8%和2.4%。此外，随时间变化的糖化血红蛋白（HbA1c）每升高一个水平，无并发症糖尿病患者向视网膜病变和死亡转移的风险比分别增加30%和67%。随时间变化的HbA1c每升高一个水平，从视网膜病变向死亡转移的风险比也增加45%。随时间变化的HbA1c相同程度的升高还分别使从单纯CAD向CAD和视网膜病变转移以及从微量白蛋白尿向视网膜病变转移的风险比增加26%和50%。
除血糖控制外，我们的研究表明，控制高血压和高脂血症在降低死亡率以及糖尿病大血管和微血管并发症方面更有效。
