Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Medicine, University of Missouri, Kansas City, Missouri.
Diabetes Research Centre, University of Leicester, Leicester.
Am Heart J. 2022 Jan;243:232-239. doi: 10.1016/j.ahj.2021.10.181. Epub 2021 Oct 16.
Micro- and macrovascular complications are a major cause of morbidity and mortality in people with type 2 diabetes (T2D). We sought to understand the global incidence rates and predictors of these complications.
We examined the incidence of vascular complications over 3 years of follow-up in the DISCOVER study-a global, observational study of people with T2D initiating second-line glucose-lowering therapy. Hierarchical Cox proportional hazards regression models examined factors associated with development of micro- and macrovascular complications during follow-up.
Among 11,357 people with T2D from 33 countries (mean age 56.9 ± 11.7 years, T2D duration 5.7 ± 5.1 years, HbA1c 8.4 ± 1.7%), 19.0% had a microvascular complication at enrolment (most commonly neuropathy), and 13.2% had a macrovascular complication (most commonly coronary disease). Over 3 years of follow-up, 16.0% developed an incident microvascular complication, and 6.6% had an incident macrovascular complication. At the end of 3 years of follow-up, 31.5% of patients had at least one microvascular complication, and 16.6% had at least one macrovascular complication. Higher HbA1c and smoking were associated with greater risk of both incident micro- and macrovascular complications. Known macrovascular complications at baseline was the strongest predictor for development of new microvascular complications (HR 1.40, 95% CI 1.21 -1.61) and new macrovascular complications (HR 3.39, 95% CI 2.84 -4.06).
In this global study, both the prevalence and 3-year incidence of vascular complications were high in patients with relatively short T2D duration, highlighting the need for early risk-factor modification.
微血管和大血管并发症是 2 型糖尿病（T2D）患者发病率和死亡率的主要原因。我们试图了解这些并发症的全球发生率和预测因素。
我们在 DISCOVER 研究中检查了 3 年随访期间血管并发症的发生率，这是一项针对 T2D 患者的全球观察性研究，他们正在接受二线降糖治疗。分层 Cox 比例风险回归模型检查了随访期间与微血管和大血管并发症发展相关的因素。
在来自 33 个国家的 11357 名 T2D 患者中（平均年龄 56.9±11.7 岁，T2D 病程 5.7±5.1 年，HbA1c 8.4±1.7%），19.0%在入组时患有微血管并发症（最常见的是神经病），13.2%患有大血管并发症（最常见的是冠心病）。在 3 年的随访期间，16.0%的患者发生了新的微血管并发症，6.6%的患者发生了大血管并发症。在 3 年随访结束时，31.5%的患者至少有一种微血管并发症，16.6%的患者至少有一种大血管并发症。较高的 HbA1c 和吸烟与新发微血管和大血管并发症的风险增加相关。基线时已知的大血管并发症是新发生微血管并发症（HR 1.40，95%CI 1.21-1.61）和新发生大血管并发症（HR 3.39，95%CI 2.84-4.06）的最强预测因素。
在这项全球研究中，具有相对较短 T2D 病程的患者的血管并发症的患病率和 3 年发生率均较高，这突出表明需要早期进行危险因素的调整。
