Department of Statistics and Institute of Data Science, College of Management, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Sci Rep. 2022 Mar 9;12(1):4177. doi: 10.1038/s41598-022-08166-4.
This study aimed to assess the impact of diabetic retinopathy (DR) severity on the incidence of major adverse cardiac events (MACE) and end-stage renal disease (ESRD) in T1D patients. Patients diagnosed with T1D between 1999 and 2013 were identified from patient-level data of Taiwan's National Health Insurance Research database. A total of 1135 patients were included and classified into mild DR (n = 454), severe DR (n = 227), or non-DR (n = 454) by using propensity score matching. Multi-state model analyses, an extension of competing risk models with adjustment for transition-specific covariates for prediction of subsequent MACE and ESRD, were performed. MACE and ESRD risks were significantly higher in the severe DR patients; a 2.97-fold (1.73, 5.07) and 12.29-fold (6.50, 23.23) increase in the MACE risk among the severe DR patients compared to the mild DR and DR-free patients, respectively; and, a 5.91-fold (3.50, 9.99) and 82.31-fold (29.07, 233.04) greater ESRD risk of severe DR patients than that of the mild DR and DR-free groups, respectively (p < 0.001). Severity of DR was significantly associated with the late diabetes-related vascular events (i.e., MACE, ESRD) among T1D patients.
本研究旨在评估糖尿病视网膜病变（DR）严重程度对 T1D 患者主要不良心脏事件（MACE）和终末期肾病（ESRD）发生率的影响。从台湾全民健康保险研究数据库的患者水平数据中确定了 1999 年至 2013 年间诊断为 T1D 的患者。共纳入 1135 例患者，并通过倾向评分匹配将其分为轻度 DR（n=454）、重度 DR（n=227）或非 DR（n=454）。多状态模型分析是竞争风险模型的扩展，通过调整特定于转换的协变量来预测随后的 MACE 和 ESRD，进行了分析。严重 DR 患者的 MACE 和 ESRD 风险显著升高；与轻度 DR 和无 DR 患者相比，严重 DR 患者的 MACE 风险分别增加了 2.97 倍（1.73，5.07）和 12.29 倍（6.50，23.23）；严重 DR 患者的 ESRD 风险分别增加了 5.91 倍（3.50，9.99）和 82.31 倍（29.07，233.04）（p<0.001）。DR 的严重程度与 T1D 患者晚期糖尿病相关血管事件（即 MACE、ESRD）显著相关。
