Miller Rachel G, Orchard Trevor J, Costacou Tina
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States.
Diabetes Res Clin Pract. 2022 Mar;185:109787. doi: 10.1016/j.diabres.2022.109787. Epub 2022 Feb 18.
Higher HbA1c has been associated with dyslipidemia in type 1 diabetes, but it is unknown whether there is heterogeneity in this association. Thus we assessed the longitudinal association between HbA1c and lipids over 30 years in a type 1 diabetes cohort and examined whether variation in such longitudinal patterns was associated with total and cause-specific mortality.
Data were from the Pittsburgh Epidemiology of Diabetes Complications study (n = 581 with ≥2 visits, 51% male, baseline mean age 27, diabetes duration 19 years). Longitudinal associations between HbA1c and lipids were assessed in mixed models. Group-based multi-trajectory models identified simultaneous trajectories of HbA1c and lipids.
Longitudinal HbA1c was associated with Non-HDLc (p < 0.0001) and triglycerides (p < 0.0001), but not HDLc (men: p = 0.72, women: p = 0.76). There was heterogeneity in the HbA1c-Non-HDLc association only, with five HbA1c-Non-HDLc groups identified. One group (20%) had an unexpected combination of high HbA1c but normal Non-HDLc and had only moderately increased cardiovascular mortality (rate ratio [RR] = 2.80, 95% CI 1.31-6.00) and kidney disease mortality (RR = 2.30, 95% CI 0.97-5.50) compared to Low HbA1c-Normal Non-HDLc.
These results suggest there is a subgroup with type 1 diabetes who, despite poor glycemic control, has a relatively good prognosis, perhaps related to good Non-HDLc.
较高的糖化血红蛋白（HbA1c）与1型糖尿病患者的血脂异常有关，但这种关联是否存在异质性尚不清楚。因此，我们评估了一个1型糖尿病队列中30年间HbA1c与血脂之间的纵向关联，并研究了这种纵向模式的变化是否与全因死亡率和特定病因死亡率相关。
数据来自匹兹堡糖尿病并发症流行病学研究（n = 581，至少有2次就诊记录，男性占51%，基线平均年龄27岁，糖尿病病程19年）。在混合模型中评估HbA1c与血脂之间的纵向关联。基于组的多轨迹模型确定了HbA1c和血脂的同步轨迹。
纵向HbA1c与非高密度脂蛋白胆固醇（Non-HDLc）（p < 0.0001）和甘油三酯（p < 0.0001）相关，但与高密度脂蛋白胆固醇（HDLc）无关（男性：p = 0.72，女性：p = 0.76）。仅在HbA1c-Non-HDLc关联中存在异质性，确定了五个HbA1c-Non-HDLc组。与低HbA1c-正常Non-HDLc组相比，一组（20%）具有高HbA1c但正常Non-HDLc的意外组合，其心血管死亡率（率比[RR]=2.80，95%可信区间1.31-6.00）和肾病死亡率（RR = 2.30，95%可信区间0.97-5.50）仅中度增加。
这些结果表明，1型糖尿病患者中有一个亚组，尽管血糖控制不佳，但预后相对较好，这可能与良好的Non-HDLc有关。
