Department of International Clinical Research Center (ICRC), St Anne's University Hospital (FNUSA), Brno, Czech Republic; Harvard University T H Chan School of Public Health, Department of Global Health and Population Boston, Massachusetts.
Icahn School of Medicine at Mount Sinai, The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone, New York, New York.
Endocr Pract. 2021 May;27(5):455-462. doi: 10.1016/j.eprac.2020.10.003. Epub 2020 Dec 16.
To determine the prevalence rate and associated risk factors for each stage of the Dysglycemia-Based Chronic Disease (DBCD) model, which 4 distinct stages and prompts early prevention to avert Diabetes and cardiometabolic complications.
Subjects between 25 and 64 years old from a random population-based sample were evaluated in Czechia from 2013 to 2014 using a cross-sectional design. DBCD stages were: stage 1 "insulin resistance" (inferred risk from abdominal obesity or a family history of diabetes); stage 2 "prediabetes"(fasting glucose between 5.6 and 6.9 mmol/L); stage 3 "type 2 diabetes (T2D)" (self-report of T2D or fasting glucose ≥7 mmol/L); and stage 4 "vascular complications" (T2D with cardiovascular disease).
A total of 2147 subjects were included (57.8% women) with a median age of 48 years. The prevalence of each DBCD stage were as follows: 54.2% (stage 1); 10.3% (stage 2), 3.7% (stage 3); and 1.2% (stage 4). Stages 2 to 4 were more frequent in men and stage 1 in women (P < .001). Using binary logistic regression analysis adjusting by age/sex, all DBCD stages were strongly associated with abnormal adiposity, hypertension, dyslipidemia, and smoking status. Subjects with lower educational levels and lower income were more likely to present DBCD.
Using the new DBCD framework and available metrics, 69.4% of the population had DBCD, identifying far more people at risk than a simple prevalence rate for T2D (9.2% in Czechia, 2013-2014). All stages were associated with traditional cardiometabolic risk factors, implicating common pathophysiologic mechanisms and a potential for early preventive care. The social determinants of health were related with all DBCD stages in alarming proportions and will need to be further studied.
确定基于糖代谢紊乱的慢性疾病（DBCD）模型各阶段的患病率及相关危险因素，该模型包含 4 个不同阶段，可提示早期预防，避免糖尿病及心血管代谢并发症。
2013 年至 2014 年，捷克采用横断面设计，对来自随机人群样本的 25 至 64 岁人群进行评估。DBCD 各阶段如下：阶段 1“胰岛素抵抗”（腹部肥胖或糖尿病家族史推断出的风险）；阶段 2“糖尿病前期”（空腹血糖 5.6 至 6.9mmol/L）；阶段 3“2 型糖尿病（T2D）”（自我报告的 T2D 或空腹血糖≥7mmol/L）；阶段 4“血管并发症”（伴有心血管疾病的 T2D）。
共纳入 2147 名受试者（57.8%为女性），中位年龄为 48 岁。各 DBCD 阶段的患病率如下：54.2%（阶段 1）；10.3%（阶段 2），3.7%（阶段 3）；1.2%（阶段 4）。男性更易发生阶段 2 至 4，女性更易发生阶段 1（P＜0.001）。经年龄/性别调整的二元逻辑回归分析表明，所有 DBCD 阶段均与异常肥胖、高血压、血脂异常和吸烟状况密切相关。受教育程度较低和收入较低的人群更易发生 DBCD。
使用新的 DBCD 框架和现有指标，69.4%的人群患有 DBCD，与简单的 T2D 患病率（2013-2014 年捷克为 9.2%）相比，发现了更多处于危险中的人群。所有阶段均与传统心血管代谢危险因素相关，提示存在共同的病理生理机制和潜在的早期预防护理。健康的社会决定因素与所有 DBCD 阶段均存在显著关系，需要进一步研究。
