Auckland Diabetes Centre, Auckland District Health Board, Auckland, Aotearoa-New Zealand
Department of Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, Aotearoa-New Zealand.
BMJ Open Diabetes Res Care. 2021 Dec;9(2). doi: 10.1136/bmjdrc-2021-002485.
Young people with type 2 diabetes (T2D) develop complications earlier than those with type 1 diabetes (T1D) of comparable duration, but it is unclear why. This apparent difference in phenotype could relate to relative inequality.
Cross-sectional study of young people referred to secondary diabetes services in Auckland, Aotearoa-New Zealand (NZ): 731 with T1D and 1350 with T2D currently aged 40 years, and diagnosed between 15 and 30 years. Outcome measures were risk factors for complications (glycemic control, urine albumin/creatinine ratio (ACR), cardiovascular disease (CVD) risk) in relation to a validated national index of deprivation (New Zealand Deprivation Index (NZDep)).
Young people with T2D were an average 3 years older than those with T1D but had a similar duration of diabetes. 71% of those with T2D were of Māori or Pasifika descent, compared with 24% with T1D (p<0.001). T1D cases were distributed evenly across NZDep categories. 78% of T2D cases were living in the lowest four NZDep categories (p<0.001). In both diabetes types, body mass index (BMI) increased progressively across the NZDep spectrum (p<0.002), as did mean glycated hemoglobin (HbA) (p<0.001), the prevalence of macroalbuminuria (p≤0.01), and CVD risk (p<0.001). Adjusting for BMI, diabetes type, and duration and age, multiple logistic regression revealed deprivation was the strongest risk factor for poorly controlled diabetes (defined as HbA >64 mmol/mol, >8%); OR 1.17, 95% CI 1.13 to 1.22, p<0.0001. Ordinal logistic regression showed each decile increase in NZDep increased the odds of a higher ACR by 11% (OR 1.11, 95% CI 1.06 to 1.16, p<0.001) following adjustment for BMI, blood pressure, diabetes type and duration, HbA, and smoking status. Multiple linear regression indicated a 4% increase in CVD risk for every decile increase in NZDep, regardless of diabetes type.
The apparent more aggressive phenotype of young-onset T2D is at least in part explicable by relative deprivation.
与病程相当的 1 型糖尿病（T1D）患者相比，年轻的 2 型糖尿病（T2D）患者更早出现并发症，但具体原因尚不清楚。这种表型上的明显差异可能与相对贫困有关。
横断面研究纳入了奥克兰（新西兰）二级糖尿病服务机构的年轻人：731 名 T1D 患者和 1350 名 T2D 患者，年龄均为 40 岁，糖尿病诊断时间为 15 至 30 岁之间。结局指标是与验证过的全国贫困指数（新西兰贫困指数（NZDep））相关的并发症风险因素（血糖控制、尿白蛋白/肌酐比值（ACR）、心血管疾病（CVD）风险）。
与 T1D 患者相比，T2D 患者的平均年龄大 3 岁，但糖尿病病程相似。71%的 T2D 患者为毛利人或太平洋岛民后裔，而 T1D 患者中这一比例为 24%（p<0.001）。T1D 患者的病例均匀分布在 NZDep 各个类别中。78%的 T2D 患者居住在 NZDep 最低的四个类别中（p<0.001）。在两种糖尿病类型中，BMI 均随着 NZDep 谱的增加而逐渐升高（p<0.002），糖化血红蛋白（HbA）均值（p<0.001）、白蛋白尿患病率（p≤0.01）和 CVD 风险（p<0.001）也逐渐升高。在调整 BMI、糖尿病类型、病程和年龄后，多因素逻辑回归显示，贫困是糖尿病控制不佳的最强危险因素（定义为 HbA>64 mmol/mol，>8%）；OR 1.17，95%CI 1.13 至 1.22，p<0.0001。有序逻辑回归显示，在调整 BMI、血压、糖尿病类型和病程、HbA 和吸烟状况后，NZDep 每增加一个等级，ACR 升高的几率增加 11%（OR 1.11，95%CI 1.06 至 1.16，p<0.001）。多元线性回归表明，无论糖尿病类型如何，NZDep 每增加一个等级，CVD 风险增加 4%。
年轻起病的 2 型糖尿病的表型似乎更为激进，这至少部分可以用相对贫困来解释。
