青少年 2 型糖尿病的长期并发症。
Long-Term Complications in Youth-Onset Type 2 Diabetes.
机构信息
From the University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora (P.B., P.Z.); George Washington University, Rockville, MD (K.L.D., B.T.); Yale University, New Haven, CT (S.C.); Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland (R.G.-K.); the Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston (D.M.N.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.T.); and Washington University School of Medicine, St. Louis (N.H.W.).
出版信息
N Engl J Med. 2021 Jul 29;385(5):416-426. doi: 10.1056/NEJMoa2100165.
BACKGROUND
The prevalence of type 2 diabetes in youth is increasing, but little is known regarding the occurrence of related complications as these youths transition to adulthood.
METHODS
We previously conducted a multicenter clinical trial (from 2004 to 2011) to evaluate the effects of one of three treatments (metformin, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention) on the time to loss of glycemic control in participants who had onset of type 2 diabetes in youth. After completion of the trial, participants were transitioned to metformin with or without insulin and were enrolled in an observational follow-up study (performed from 2011 to 2020), which was conducted in two phases; the results of this follow-up study are reported here. Assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease were performed annually, and assessments for retinal disease were performed twice. Complications related to diabetes identified outside the study were confirmed and adjudicated.
RESULTS
At the end of the second phase of the follow-up study (January 2020), the mean (±SD) age of the 500 participants who were included in the analyses was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years. The cumulative incidence of hypertension was 67.5%, the incidence of dyslipidemia was 51.6%, the incidence of diabetic kidney disease was 54.8%, and the incidence of nerve disease was 32.4%. The prevalence of retinal disease, including more advanced stages, was 13.7% in the period from 2010 to 2011 and 51.0% in the period from 2017 to 2018. At least one complication occurred in 60.1% of the participants, and at least two complications occurred in 28.4%. Risk factors for the development of complications included minority race or ethnic group, hyperglycemia, hypertension, and dyslipidemia. No adverse events were recorded during follow-up.
CONCLUSIONS
Among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by the time of young adulthood. Complications were more common among participants of minority race and ethnic group and among those with hyperglycemia, hypertension, and dyslipidemia. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov numbers, NCT01364350 and NCT02310724.).
背景
2 型糖尿病在年轻人中的发病率正在上升，但对于这些年轻人在向成年过渡时相关并发症的发生情况却知之甚少。
方法
我们之前进行了一项多中心临床试验（2004 年至 2011 年），以评估三种治疗方法（二甲双胍、二甲双胍加罗格列酮或二甲双胍加强化生活方式干预）中哪一种治疗方法对年轻人起病的 2 型糖尿病患者血糖控制丧失时间的影响。试验完成后，参与者转为服用二甲双胍加或不加胰岛素，并参加了一项观察性随访研究（2011 年至 2020 年进行），该研究分为两个阶段；这里报告的是这项随访研究的结果。每年进行糖尿病肾病、高血压、血脂异常和神经疾病的评估，每两年进行一次视网膜疾病的评估。对研究之外发现的与糖尿病相关的并发症进行确认和裁决。
结果
在随访研究第二阶段结束时（2020 年 1 月），纳入分析的 500 名参与者的平均（±SD）年龄为 26.4±2.8 岁，糖尿病诊断后平均时间为 13.3±1.8 年。高血压的累积发病率为 67.5%，血脂异常的发病率为 51.6%，糖尿病肾病的发病率为 54.8%，神经疾病的发病率为 32.4%。视网膜疾病的患病率（包括更严重的阶段）在 2010 年至 2011 年期间为 13.7%，在 2017 年至 2018 年期间为 51.0%。60.1%的参与者至少发生了一种并发症，28.4%的参与者至少发生了两种并发症。并发症发生的危险因素包括少数民族、高血糖、高血压和血脂异常。随访期间未记录到不良事件。
结论
在年轻人中起病的 2 型糖尿病患者中，包括微血管并发症在内的并发症风险随时间稳步增加，在成年早期时影响大多数患者。并发症在少数民族和种族群体以及高血糖、高血压和血脂异常的参与者中更为常见。（由国家糖尿病、消化和肾脏疾病研究所等资助；临床试验.gov 编号，NCT01364350 和 NCT02310724。）
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