Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan.
Diabetes Care. 2021 Mar;44(3):757-764. doi: 10.2337/dc20-1213. Epub 2021 Jan 13.
OBJECTIVE: Prediabetes has been suggested to increase risk for death; however, the definitions of prediabetes that can predict death remain elusive. We prospectively investigated the association of multiple definitions of prediabetes with the risk of death from all causes, cardiovascular disease (CVD), and cancer in Japanese workers. RESEARCH DESIGN AND METHODS: The study included 62,785 workers who underwent a health checkup in 2010 or 2011 and were followed up for death from 2012 to March 2019. Prediabetes was defined according to fasting plasma glucose (FPG) or glycated hemoglobin (HbA) values or a combination of both using the American Diabetes Association (ADA) or World Health Organization (WHO)/International Expert Committee (IEC) criteria. The Cox proportional hazards regression model was used to investigate the associations. RESULTS: Over a 7-year follow-up, 229 deaths were documented. Compared with normoglycemia, prediabetes defined according to ADA criteria was associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.53; 95% CI 1.12-2.09) and death due to cancer (HR 2.37; 95% CI 1.45-3.89) but not with death due to CVD. The results were materially unchanged when prediabetes was defined according to ADA FPG, ADA HbA, WHO FPG, or combined WHO/IEC criteria. Diabetes was associated with the risk of all-cause, CVD, and cancer deaths. CONCLUSIONS: In a cohort of Japanese workers, FPG- and HbA-defined prediabetes, according to ADA or WHO/IEC, were associated with a significantly increased risk of death from all causes and cancer but not CVD.
目的:有研究表明,前驱糖尿病会增加死亡风险;然而,能够预测死亡风险的前驱糖尿病定义仍不明确。我们前瞻性地研究了多种前驱糖尿病定义与日本工人全因死亡、心血管疾病(CVD)和癌症死亡风险的相关性。
研究设计和方法:这项研究纳入了 62785 名于 2010 年或 2011 年接受健康检查、并随访至 2019 年 3 月期间全因死亡的工人。根据空腹血糖(FPG)或糖化血红蛋白(HbA)值,或采用美国糖尿病协会(ADA)或世界卫生组织(WHO)/国际专家委员会(IEC)标准,同时使用 FPG 和 HbA 值对前驱糖尿病进行定义。采用 Cox 比例风险回归模型来分析相关性。
结果:在 7 年的随访期间,共记录到 229 例死亡。与血糖正常相比,根据 ADA 标准定义的前驱糖尿病与全因死亡率(风险比 [HR] 1.53;95%CI 1.12-2.09)和癌症死亡率(HR 2.37;95%CI 1.45-3.89)的升高显著相关,但与 CVD 死亡率无关。当根据 ADA FPG、ADA HbA、WHO FPG 或联合 WHO/IEC 标准来定义前驱糖尿病时,结果基本保持不变。糖尿病与全因、CVD 和癌症死亡风险相关。
结论:在日本工人队列中,根据 ADA 或 WHO/IEC 标准,FPG 和 HbA 定义的前驱糖尿病与全因死亡和癌症死亡风险的显著增加相关,但与 CVD 无关。
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