20至45岁年轻成年人中1型糖尿病的发病率及预测因素：青年成人糖尿病（DiYA）研究
Incidence and predictors of type 1 diabetes among younger adults aged 20-45 years: The diabetes in young adults (DiYA) study.
作者信息
Lawrence Jean M, Slezak Jeff M, Quesenberry Charles, Li Xia, Yu Liping, Rewers Marian, Alexander Janet G, Takhar Harpreet S, Sridhar Sneha, Albright Ann, Rolka Deborah B, Saydah Sharon, Imperatore Giuseppina, Ferrara Assiamira
机构信息
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2(nd) floor, Pasadena, CA 91101, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2(nd) floor, Pasadena, CA 91101, USA.
出版信息
Diabetes Res Clin Pract. 2021 Jan;171:108624. doi: 10.1016/j.diabres.2020.108624. Epub 2020 Dec 15.
AIMS
To estimate incidence of type 1 diabetes (T1D) and to develop a T1D prediction model among young adults.
METHODS
Adults 20-45 years newly-diagnosed with diabetes in 2017 were identified within Kaiser Permanente's healthcare systems in California and invited for diabetes autoantibody (DAA) testing. Multiple imputation was conducted to assign missing DAA status. The primary outcome for incidence rates (IR) and the prediction model was T1D defined by ≥1 positive DAA.
RESULTS
Among 2,347,989 persons at risk, 7862 developed diabetes, 2063 had DAA measured, and 166 (8.0%) had ≥1 positive DAA. T1D IR (95% CI) per 100,000 person-years was 15.2 (10.2-20.1) for ages 20-29 and 38.2 (28.6-47.8) for ages 30-44 years. The age-standardized IRs were 32.5 (22.2-42.8) for men and 27.2 (21.0-34.5) for women. The age/sex-standardized IRs were 30.1 (23.5-36.8) overall; 41.4 (25.3-57.5) for Hispanics, 37.0 (11.6-62.4) for Blacks, 21.4 (14.3-28.6) for non-Hispanic Whites, and 19.4 (8.5-30.2) for Asians. Predictors of T1D among cases included female sex, younger age, lower BMI, insulin use and having T1D based on diagnostic codes.
CONCLUSIONS
T1D may account for up to 8% of incident diabetes cases among young adults. Follow-up is needed to establish the clinical course of patients with one DAA at diagnosis.
目的
评估1型糖尿病（T1D）的发病率，并建立年轻成年人T1D预测模型。
方法
在加利福尼亚州凯撒医疗系统中识别出2017年新诊断为糖尿病的20 - 45岁成年人，并邀请他们进行糖尿病自身抗体（DAA）检测。采用多重填补法来确定缺失的DAA状态。发病率（IR）和预测模型的主要结局是由≥1种阳性DAA定义的T1D。
结果
在2347989名有风险的人群中，7862人患糖尿病，2063人进行了DAA检测，166人（8.0%）有≥1种阳性DAA。20 - 29岁人群每10万人年的T1D发病率（95%CI）为15.2（10.2 - 20.1），30 - 44岁人群为38.2（28.6 - 47.8）。年龄标准化发病率男性为32.5（22.2 - 42.8），女性为27.2（21.0 - 34.5）。总体年龄/性别标准化发病率为30.1（23.5 - 36.8）；西班牙裔为41.4（25.3 - 57.5），黑人37.0（11.6 - 62.4），非西班牙裔白人21.4（14.3 - 28.6），亚洲人19.4（8.5 - 30.2）。病例中T1D的预测因素包括女性、年龄较小、BMI较低、使用胰岛素以及根据诊断编码患有T1D。
结论
T1D可能占年轻成年人新发糖尿病病例的8%。需要进行随访以确定诊断时有一种DAA的患者的临床病程。
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