Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
Divisoin of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2021 Apr;9(1). doi: 10.1136/bmjdrc-2020-001776.
We conducted a systematic review and meta-analysis to evaluate the updated evidence regarding prediabetes for predicting mortality, macrovascular and microvascular outcomes.
We identified English language studies from MEDLINE, PubMed, OVID and Cochrane database indexed from inception to January 31, 2020. Paired reviewers independently identified 106 prospective studies, comprising nearly 1.85 million people, from 27 countries. Primary outcomes were all-cause mortality (ACM), cardiovascular mortality (CVDM), cardiovascular disease (CVD), coronary heart disease (CHD) and stroke. Secondary outcomes were heart failure, chronic kidney disease (CKD) and retinopathy.
Impaired glucose tolerance was associated with ACM; HR 1.19, 95% CI (1.15 to 1.24), CVDM; HR 1.21, 95% CI (1.10 to 1.32), CVD; HR 1.18, 95% CI (1.11 to 1.26), CHD; HR; 1.13, 95% CI (1.05 to 1.21) and stroke; HR 1.24, 95% CI (1.06 to 1.45). Impaired fasting glucose (IFG) 110-125 mg/dL was associated with ACM; HR 1.17, 95% CI (1.13 to 1.22), CVDM; HR 1.20, 95% CI (1.09 to 1.33), CVD; HR 1.21, 95% CI (1.09 to 1.33), CHD; HR; 1.14, 95% CI (1.06 to 1.22) and stroke; HR 1.22, 95% CI (1.07 to 1.40). IFG 100-125 mg/dL was associated with ACM; HR 1.11, 95% CI (1.04 to 1.19), CVDM; HR 1.14, 95% CI (1.03 to 1.25), CVD; HR 1.15, 95% CI (1.05 to 1.25), CHD HR; 1.10, 95% CI (1.02 to 1.19) and CKD; HR; 1.09, 95% CI (1.01 to 1.18). Glycosylated hemoglobin A1c (HbA1c) 6.0%-6.4% was associated with ACM; HR 1.30, 95% CI (1.03 to 1.66), CVD; HR 1.32, 95% CI (1.00 to 1.73) and CKD; HR 1.50, 95% CI (1.32 to 1.70). HbA1c 5.7%-6.4% was associated with CVD HR 1.15, 95% CI (1.02 to 1.30), CHD; HR 1.28, 95% CI (1.13 to 1.46), stroke; HR 1.23, 95% CI (1.04 to 1.46) and CKD; HR 1.32, 95% CI (1.16 to 1.50).
Prediabetes is an elevated risk state for macrovascular and microvascular outcomes. The prevention and management of prediabetes should be considered.
我们进行了一项系统评价和荟萃分析，以评估关于糖尿病前期预测死亡率、大血管和微血管结局的最新证据。
我们从 MEDLINE、PubMed、OVID 和 Cochrane 数据库中确定了从成立到 2020 年 1 月 31 日索引的英语研究。配对审查员独立从 27 个国家确定了近 185 万人的 106 项前瞻性研究。主要结局是全因死亡率（ACM）、心血管死亡率（CVDM）、心血管疾病（CVD）、冠心病（CHD）和中风。次要结局是心力衰竭、慢性肾脏病（CKD）和视网膜病变。
糖耐量受损与 ACM 相关；HR 1.19，95%CI（1.15 至 1.24），CVDM；HR 1.21，95%CI（1.10 至 1.32），CVD；HR 1.18，95%CI（1.11 至 1.26），CHD；HR 1.13，95%CI（1.05 至 1.21）和中风；HR 1.24，95%CI（1.06 至 1.45）。110-125mg/dL 的空腹血糖受损与 ACM 相关；HR 1.17，95%CI（1.13 至 1.22），CVDM；HR 1.20，95%CI（1.09 至 1.33），CVD；HR 1.21，95%CI（1.09 至 1.33），CHD；HR 1.14，95%CI（1.06 至 1.22）和中风；HR 1.22，95%CI（1.07 至 1.40）。100-125mg/dL 的空腹血糖受损与 ACM 相关；HR 1.11，95%CI（1.04 至 1.19），CVDM；HR 1.14，95%CI（1.03 至 1.25），CVD；HR 1.15，95%CI（1.05 至 1.25），CHD HR 1.10，95%CI（1.02 至 1.19）和 CKD；HR 1.09，95%CI（1.01 至 1.18）。糖化血红蛋白 A1c（HbA1c）6.0%-6.4%与 ACM 相关；HR 1.30，95%CI（1.03 至 1.66），CVD；HR 1.32，95%CI（1.00 至 1.73）和 CKD；HR 1.50，95%CI（1.32 至 1.70）。HbA1c 5.7%-6.4%与 CVD HR 1.15，95%CI（1.02 至 1.30），CHD；HR 1.28，95%CI（1.13 至 1.46），中风；HR 1.23，95%CI（1.04 至 1.46）和 CKD；HR 1.32，95%CI（1.16 至 1.50）相关。
糖尿病前期是大血管和微血管结局的高危状态。应考虑预防和管理糖尿病前期。
