Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Diabetes Care. 2021 Jan;44(1):81-88. doi: 10.2337/dc20-2030. Epub 2020 Nov 10.
Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH).
The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM.
Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2-53.7); after adjustment for RTM, in 20.2% (95% CI 12.1-28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9-41.3) or in 23.7% (95% CI 22.6-24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4-28.1) and 19.4% (95% CI 18.4-20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26-1.84) and IH (relative risk 1.30, 95% CI 1.17-1.45).
In this quasi-real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.
血糖回归在真实环境中很常见，但对回归均值（RTM）的贡献研究甚少。我们旨在评估新确诊糖尿病和中间高血糖（IH）成年人的自由生活队列中，在调整 RTM 前后的血糖回归情况。
巴西成人健康纵向研究（ELSA-Brasil）是一项对 2008 年至 2010 年筛查的 15105 名成年人进行的队列研究，他们接受了标准化口服葡萄糖耐量试验和 HbA 检测，在 3.84±0.42 年后再次进行检测。在排除接受糖尿病治疗的人群后，我们计算了基线值调整 RTM 前后的部分或完全回归情况。
在新确诊的糖尿病患者中，部分或完全回归的比例为 49.4%（95%CI 45.2-53.7）；在调整 RTM 后，这一比例为 20.2%（95%CI 12.1-28.3）。在 IH 患者中，回归到正常水平的比例分别为 39.5%（95%CI 37.9-41.3）或 23.7%（95%CI 22.6-24.3），具体取决于采用世界卫生组织（WHO）或美国糖尿病协会（ADA）的定义；调整后，相应的频率分别为 26.1%（95%CI 22.4-28.1）和 19.4%（95%CI 18.4-20.5）。调整 RTM 后，筛查出的病例数减少：糖尿病病例从 526 例减少至 94 例，WHO 定义的 IH 病例从 3118 例减少至 1986 例，ADA 定义的 IH 病例从 6182 例减少至 5711 例。体重减轻≥2.6%与糖尿病（相对风险 1.52，95%CI 1.26-1.84）和 IH（相对风险 1.30，95%CI 1.17-1.45）的回归程度更大有关。
在这个准现实环境中，约 4 年后糖尿病的回归较为常见，IH 的回归则较为少见。回归在很大程度上归因于 RTM，但在一定程度上也与随访期间体重减轻和内稳态的改善有关。
