Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
School of Health and Biomedical Sciences, RMIT, Melbourne, Victoria, Australia.
Diabetes Obes Metab. 2021 May;23(5):1150-1161. doi: 10.1111/dom.14323. Epub 2021 Mar 12.
To evaluate temporal patterns in co-morbidities, cardiometabolic risk factors and a high atherosclerotic cardiovascular disease (ASCVD) risk population at type 2 diabetes (T2D) diagnosis by age groups and sex.
From the UK primary care database, 248,619 people with a new diagnosis of T2D during 2005-2016 were identified. Among people without ASCVD, high ASCVD risk was defined as two or more of current smoker, grade 2+ obesity, hypertension, dyslipidaemia or microvascular disease. Cardiometabolic multimorbidity (CMM) was defined as two or more of cardiovascular disease, microvascular disease, hypertension, dyslipidaemia, grade 2+ obesity or cancer. Temporal patterns in the distribution of cardiometabolic risk factors were evaluated.
While the prevalence of ASCVD was stable over time (approximately 18%), 50% were identified to have a high ASCVD risk (26% and 38% in the 18-39 and 40-49 years age groups, respectively), with an increasing trend across all age groups. Overall, 51% had CMM at diagnosis, increasing during 2005-2016 for the 18-39 years age group by 14%-17%, for the 40-49 years age group by 27%-33%, for the 50-59 years age group by 41%-50%, for the 60-69 years age group by 56%-65%, and for the 70-79 years age group by 65%-80%. People with young-onset T2D had significantly higher HbA1c, body mass index and lipids at diagnosis (all p < .01). The proportions with an HbA1c of 7.5% or higher in the 18-39 and 40-49 years age groups were 58% and 54%, respectively, significantly and consistently higher over the last decade compared with those aged 50 years or older, with males having higher proportions of 15-26 and 10-18 percentage points, respectively, compared with females.
CMM and high ASCVD risk have been increasing consistently across all age groups and in both sex, in particular CMM in those aged younger than 50 years. Our findings indicate that the European Society of Cardiology-European Association for the Study of Diabetes recommendations need to change to consider people with young-onset T2D as a high-risk group, as recommended in the Primary Care Diabetes Europe position statement.
按年龄组和性别评估 2 型糖尿病（T2D）诊断时合并症、心血管代谢危险因素和高危动脉粥样硬化性心血管疾病（ASCVD）人群的时间模式。
从英国初级保健数据库中确定了 2005-2016 年期间新诊断为 T2D 的 248619 人。在没有 ASCVD 的人群中，高 ASCVD 风险定义为当前吸烟者、2 级以上肥胖、高血压、血脂异常或微血管疾病两项或以上。心血管代谢合并症（CMM）定义为心血管疾病、微血管疾病、高血压、血脂异常、2 级以上肥胖或癌症两项或以上。评估了心血管代谢危险因素分布的时间模式。
虽然 ASCVD 的患病率在一段时间内保持稳定（约 18%），但 50%的人被认为具有高 ASCVD 风险（18-39 岁年龄组中分别为 26%和 38%，所有年龄组均呈上升趋势）。总体而言，51%的人在诊断时患有 CMM，18-39 岁年龄组在 2005-2016 年间增加了 14%-17%，40-49 岁年龄组增加了 27%-33%，50-59 岁年龄组增加了 41%-50%，60-69 岁年龄组增加了 56%-65%，70-79 岁年龄组增加了 65%-80%。患有早发性 T2D 的人在诊断时的糖化血红蛋白、体重指数和血脂明显更高（均 P<.01）。18-39 岁和 40-49 岁年龄组中 HbA1c 为 7.5%或更高的比例分别为 58%和 54%，在过去十年中一直持续且显著高于 50 岁或以上的人群，男性的比例分别比女性高 15-26 和 10-18 个百分点。
CMM 和高危 ASCVD 风险在所有年龄组和性别中持续增加，尤其是 50 岁以下人群的 CMM。我们的研究结果表明，欧洲心脏病学会-欧洲糖尿病研究协会的建议需要改变，以考虑将年轻起病的 T2D 患者视为高危人群，正如初级保健糖尿病欧洲立场声明中所建议的那样。
