Internal Medicine 'C' and Diabetes Service, Assaf Harofeh Medical Center, Zerifin, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BMJ Open Diabetes Res Care. 2021 Mar;9(1). doi: 10.1136/bmjdrc-2020-001981.
We examined years of potential life lost (YPLL) associated with pre-diabetes as compared with either normoglycemia or diabetes, using data of the Israel cohort of Glucose intolerance, Obesity and Hypertension 40-year follow-up.
Men and women (N=2844, mean age 52.0±8.2 years) who underwent oral glucose tolerance test and anthropometric measurements, during 1976-1982, were followed for mortality until May 2019. Multiple imputation procedures for missing mortality dates and multivariable regression mixed models were applied.
At baseline, 35.8%, 48.8% and 15.4% individuals were found with normoglycemia, pre-diabetes, and diabetes, respectively. The average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 4.3 years (95% CI 3.3 to 5.2; p<0.001). YPLL were 1 year higher in women with pre-diabetes than in men with pre-diabetes. These differences persisted mainly in individuals younger than 60 years, and those with body mass index (BMI) <25 kg/m, at baseline. Adjusting for age, sex, country of origin, smoking status, BMI, and blood pressure, the average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 2.0 years (95% CI 1.2 to 2.8; p<0.001). Significant reductions of 5.9 years (95% CI 4.8 to 7.0) on average were observed for diabetes as compared with pre-diabetes and 7.9 years (95% CI 6.7 to 9.1) as compared with individuals with normoglycemia.
This study reveals that life expectancy of middle-aged individuals with pre-diabetes is shorter than of normoglycemic ones. These findings are especially relevant in view of the rising worldwide prevalence of pre-diabetes within younger age groups and underscore the crucial importance of interventions by either lifestyle modification or drug therapy capable of delaying progression from pre-diabetes to diabetes to reduce the YPLL in this high-risk group.
我们研究了与前驱糖尿病相关的潜在寿命损失（YPLL）与正常血糖或糖尿病相比的情况，使用了以色列葡萄糖耐量异常、肥胖和高血压 40 年随访队列的数据。
1976 年至 1982 年期间，接受口服葡萄糖耐量试验和人体测量的男性和女性（N=2844 人，平均年龄 52.0±8.2 岁），随访至 2019 年 5 月的死亡率。对于缺失的死亡率日期，采用多重插补程序，使用多变量回归混合模型。
在基线时，分别有 35.8%、48.8%和 15.4%的个体被诊断为正常血糖、前驱糖尿病和糖尿病。与正常血糖相比，前驱糖尿病的 YPLL 平均差异为 4.3 年（95%CI 3.3 至 5.2；p<0.001）。与男性相比，女性的 YPLL 更高，女性的 YPLL 比男性高 1 岁。这些差异主要存在于年龄小于 60 岁的个体以及基线时 BMI<25kg/m2的个体中。在调整年龄、性别、原籍国、吸烟状况、BMI 和血压后，与正常血糖相比，前驱糖尿病的 YPLL 平均差异为 2.0 年（95%CI 1.2 至 2.8；p<0.001）。与前驱糖尿病相比，糖尿病的 YPLL 平均减少了 5.9 年（95%CI 4.8 至 7.0），与正常血糖相比，糖尿病的 YPLL 减少了 7.9 年（95%CI 6.7 至 9.1）。
这项研究表明，中年前驱糖尿病患者的预期寿命短于正常血糖患者。鉴于全球年轻人群中前驱糖尿病的患病率不断上升，这些发现尤其重要，强调了通过生活方式改变或药物治疗进行干预的重要性，以延缓从前驱糖尿病到糖尿病的进展，从而减少该高风险人群的 YPLL。
