The School of Medicine and Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK.
Int J Clin Pract. 2021 Nov;75(11):e14695. doi: 10.1111/ijcp.14695. Epub 2021 Sep 2.
Type 2 diabetes mellitus (T2DM) frequently associates with increasing multi-morbidity/treatment complexity. Some headway has been made to identify genetic and non-genetic risk factors for T2DM. However, longitudinal clinical histories of individuals both before and after diagnosis of T2DM are likely to provide additional insight into both diabetes aetiology/further complex trajectory of multi-morbidity.
This study utilised diabetes patients/controls enrolled in the DARE (Diabetes Alliance for Research in England) study where pre- and post-T2DM diagnosis longitudinal data was available for trajectory analysis. Longitudinal data of 281 individuals (T2DM n = 237 vs matched non-T2DM controls n = 44) were extracted, checked for errors and logical inconsistencies and then subjected to Trajectory Analysis over a period of up to 70 years based on calculations of the proportions of most prominent clinical conditions for each year.
For individuals who eventually had a diagnosis of T2DM made, a number of clinical phenotypes were seen to increase consistently in the years leading up to diagnosis of T2DM. Of these documented phenotypes, the most striking were diagnosed hypertension (more than in the control group) and asthma. This trajectory over time was much less dramatic in the matched control group. Immediately prior to T2DM diagnosis, a greater indication of ischaemic heart disease proportions was observed. Post-T2DM diagnosis, the proportions of T2DM patients exhibiting hypertension and infection continued to climb rapidly before plateauing. Ischaemic heart disease continued to increase in this group as well as retinopathy, impaired renal function and heart failure.
These observations provide an intriguing and novel insight into the onset and natural progression of T2DM. They suggest an early phase of potentially related disease activity well before any clinical diagnosis of diabetes is made. Further studies on a larger cohort of DARE patients are underway to explore the utility of establishing predictive risk scores.
2 型糖尿病（T2DM）常伴有多种合并症/治疗复杂性增加。已经在一定程度上确定了 T2DM 的遗传和非遗传风险因素。然而，个体在诊断 T2DM 之前和之后的纵向临床病史可能会提供更多关于糖尿病发病机制/多种合并症进一步复杂轨迹的见解。
本研究利用了在 DARE（英格兰糖尿病联盟研究）研究中招募的糖尿病患者/对照者，该研究中有 T2DM 诊断前后的纵向数据可供轨迹分析。提取了 281 名个体（T2DM n=237 与匹配的非 T2DM 对照组 n=44）的纵向数据，检查错误和逻辑不一致，然后根据每年最主要临床疾病的比例进行长达 70 年的轨迹分析。
对于最终被诊断为 T2DM 的个体，在诊断 T2DM 之前的几年中，观察到许多临床表型持续增加。在这些记录的表型中，最显著的是诊断为高血压（比对照组更常见）和哮喘。这种随时间的轨迹在匹配的对照组中则不那么明显。在 T2DM 诊断之前，观察到缺血性心脏病比例的增加。在 T2DM 诊断后，患有高血压和感染的 T2DM 患者的比例继续迅速攀升，然后趋于平稳。在该组中，缺血性心脏病继续增加，还有视网膜病变、肾功能损害和心力衰竭。
这些观察结果为 T2DM 的发病和自然进展提供了一个有趣和新颖的视角。它们表明，在做出任何临床糖尿病诊断之前，存在潜在相关疾病活动的早期阶段。正在对更大的 DARE 患者队列进行进一步研究，以探讨建立预测风险评分的效用。
