2 型糖尿病患者的血糖达标时间与癌症死亡率之间的关联：一项前瞻性队列研究。

Association between time in range and cancer mortality among patients with type 2 diabetes: a prospective cohort study.

机构信息

Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.

Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.

出版信息

Chin Med J (Engl). 2021 Sep 15;135(3):288-294. doi: 10.1097/CM9.0000000000001740.

DOI:10.1097/CM9.0000000000001740

PMID:34995040

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8812706/

Abstract

BACKGROUND

Little was known about the association among time in range (TIR), time above range (TAR), time below range (TBR), and cancer mortality among patients with type 2 diabetes. We aimed to investigate the association among TIR, TAR, TBR, and the risk of cancer mortality among patients with type 2 diabetes.

METHODS

A total of 6225 patients with type 2 diabetes were prospectively recruited in Shanghai, China. TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period. Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality.

RESULTS

During a mean follow-up of 7.10 years, we confirmed 237 death events related to cancer. The multivariable-adjusted hazard ratio (HR) for cancer mortality was 1.32 (95% confidence interval [CI]: 1.01-1.75) in patients with TIR ≤70% compared with those with TIR >70%. When TIR was considered as a continuous variable, the multivariable-adjusted HR for cancer mortality associated with each 10% decrease in TIR was 1.07 (95% CI: 1.02-1.14). In the site-specific analysis, a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found (HR: 1.24; 95% CI: 1.09-1.41). However, no relationship between hemoglobin A1c and cancer mortality was observed (HR: 1.04; 95% CI: 0.97-1.10).

CONCLUSIONS

The present study found an inverse association of TIR with the risk of cancer mortality among patients with type 2 diabetes. New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with type 2 diabetes.

摘要

背景

关于 2 型糖尿病患者的时间在目标范围内（TIR）、时间在目标范围之上（TAR）、时间在目标范围之下（TBR）与癌症死亡率之间的关联，人们知之甚少。本研究旨在探讨 TIR、TAR、TBR 与 2 型糖尿病患者癌症死亡率风险之间的关联。

方法

本研究前瞻性招募了中国上海的 6225 例 2 型糖尿病患者。TIR 是在基线时通过连续血糖监测测量的，定义为 24 小时内目标血糖范围内的平均时间百分比。使用 Cox 比例风险回归分析来确定 TIR 与癌症死亡率风险之间的关系。

结果

在平均 7.10 年的随访期间，我们确认了 237 例与癌症相关的死亡事件。与 TIR＞70%的患者相比，TIR≤70%的患者癌症死亡率的多变量调整后的风险比（HR）为 1.32（95%置信区间[CI]：1.01-1.75）。当 TIR 被视为连续变量时，与 TIR 每降低 10%相关的癌症死亡率的多变量调整后的 HR 为 1.07（95% CI：1.02-1.14）。在特定部位分析中，TIR 作为连续变量与肝癌风险之间存在显著关联（HR：1.24；95% CI：1.09-1.41）。然而，血红蛋白 A1c 与癌症死亡率之间没有关系（HR：1.04；95% CI：0.97-1.10）。