肥胖与 2 型糖尿病患者微血管疾病的相关性。

Association Between Obesity and Microvascular Diseases in Patients With Type 2 Diabetes Mellitus.

机构信息

Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China.

Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China.

出版信息

Front Endocrinol (Lausanne). 2021 Oct 26;12:719515. doi: 10.3389/fendo.2021.719515. eCollection 2021.

UNLABELLED

This study aimed to evaluate the association between obesity, evaluated by fat mass index (FMI) with the risk of microvascular diseases in patients with type 2 diabetes mellitus (T2DM) and compare the magnitude of associations of FMI, body mass index (BMI), and waist circumference (WC) with the risk of microvascular diseases. We performed a analysis of the Action to Control Cardiovascular Risk in Diabetes study. The primary microvascular outcomes of the present study included chronic kidney disease (CKD) progression, retinopathy, and neuropathy. Cox proportional-hazards models were performed to evaluate the association of FMI with microvascular diseases. A discordant analysis was performed to compare the magnitude of associations of FMI, BMI, and WC with the risk of microvascular diseases. Our study included 10,251 T2DM participants with a median of 5 years (interquartile range, 4.2-5.7) of follow-up. A total of 6,184 participants developed CKD progression, 896 participants had retinopathy, and 3,213 participants developed neuropathy (Michigan Neuropathy Screening Instrument, >2.0). After the confounding factors were adjusted for, patients in the highest FMI quartile had a higher risk of CKD progression (HR: 1.26, 95%CI: 1.16-1.36) and neuropathy (HR: 1.93, 95% CI: 1.74-2.15), except for retinopathy (HR: 1.17, 95% CI: 0.96-1.43), than those in the lowest quartile. Discordant analyses found that FMI and WC are better in identifying individuals with obesity-related risk of neuropathy, compared with BMI; neither is better in identifying individuals with obesity-related risk of CKD progression and retinopathy. Obesity is associated with CKD progression and neuropathy in T2DM participants. Further randomized trials are needed to test whether obesity control can improve the outcomes of T2DM participants with CKD or neuropathy. FMI and WC are more useful in identifying obesity-related risk of neuropathy compared with BMI in T2DM patients.

CLINICAL TRIAL REGISTRATION

http://www.clinicaltrials.gov, NCT00000620.

本研究旨在评估脂肪量指数（FMI）评估的肥胖与 2 型糖尿病（T2DM）患者微血管疾病风险之间的关联，并比较 FMI、体重指数（BMI）和腰围（WC）与微血管疾病风险的关联程度。我们对心血管风险控制行动研究进行了分析。本研究的主要微血管结局包括慢性肾脏病（CKD）进展、视网膜病变和神经病变。采用 Cox 比例风险模型评估 FMI 与微血管疾病的关联。进行了不一致分析，以比较 FMI、BMI 和 WC 与微血管疾病风险的关联程度。我们的研究纳入了 10251 名 T2DM 参与者，中位随访时间为 5 年（四分位距，4.2-5.7）。共有 6184 名参与者发生 CKD 进展，896 名参与者出现视网膜病变，3213 名参与者出现神经病变（密歇根神经病变筛查工具，>2.0）。在调整混杂因素后，FMI 最高四分位的患者发生 CKD 进展（HR：1.26，95%CI：1.16-1.36）和神经病变（HR：1.93，95%CI：1.74-2.15）的风险更高，除外视网膜病变（HR：1.17，95%CI：0.96-1.43）。不一致分析发现，与 BMI 相比，FMI 和 WC 更能识别肥胖与神经病变相关的风险；两者都不能更好地识别肥胖与 CKD 进展和视网膜病变相关的风险。肥胖与 T2DM 参与者的 CKD 进展和神经病变相关。需要进一步的随机试验来测试肥胖控制是否可以改善 CKD 或神经病变的 T2DM 参与者的结局。在 T2DM 患者中，FMI 和 WC 比 BMI 更能识别肥胖相关的神经病变风险。