Tu Zhou-Zheng, Yuan Yu, Xia Peng-Fei, Lu Qi, Chen Shuo-Hua, Wang Guo-Dong, Zheng Meng-Yi, Zhang Yan-Bo, Chen Jun-Xiang, Zhou Yan-Feng, Liu Gang, Wu Shou-Ling, Pan An
Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, China.
Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Diabetes Metab. 2022 Sep;48(5):101348. doi: 10.1016/j.diabet.2022.101348. Epub 2022 Apr 19.
China has the largest number of adults with diabetes. Although multiple metabolic risk factors (MRFs) are implicated in the development of diabetes, it remains unclear how they progress during the development of diabetes among Chinese. We examined trajectories of multiple MRFs among Chinese and identified the critical period when drastic changes occurred during the development of diabetes.
This prospective cohort study included participants since 2006-2007 in the Kailuan study. People attended biennial examinations until 2017 with additions of new participants at each examination cycle. The time when a participant first completed the examination was served as the baseline. A total of 122,659 participants without prevalent diabetes at baseline and with complete follow-up data were included. MRFs were collected via biennial physical examinations and laboratory measures. Incident diabetes cases were identified via biennial fasting glucose tests and self-reported physician-diagnosis.
During up to 12 years of follow-up, 14,922 incident diabetes cases were identified. Compared with participants who did not develop diabetes, those who developed diabetes had more adverse levels of most MRFs at baseline and during follow-up. Abrupt increases in multiple MRFs (including fasting glucose, surrogate insulin resistance indicators, lipids, systolic blood pressure, pulse pressure, heart rate, alanine aminotransferase, and C-reactive protein) were observed 3 years before the diagnosis of diabetes.
We identified 3 years before diabetes diagnosis as a critical period when multiple MRFs experienced drastic changes. This would have implications for early monitoring and timely prevention for individuals who experience sudden adverse progression of multiple MRFs.
中国成年糖尿病患者数量居全球之首。尽管多种代谢危险因素（MRFs）与糖尿病的发生有关，但在中国人群中，这些因素在糖尿病发展过程中的变化情况仍不清楚。我们研究了中国人群中多种MRFs的变化轨迹，并确定了糖尿病发展过程中发生剧烈变化的关键时期。
这项前瞻性队列研究纳入了自2006 - 2007年起参加开滦研究的参与者。参与者每两年接受一次检查，每个检查周期都有新参与者加入。参与者首次完成检查的时间作为基线。共纳入122,659名基线时无糖尿病且有完整随访数据的参与者。MRFs通过每两年一次的体格检查和实验室检测收集。新发糖尿病病例通过每两年一次的空腹血糖检测和自我报告的医生诊断来确定。
在长达12年的随访期间，共确定了14,922例新发糖尿病病例。与未患糖尿病的参与者相比，患糖尿病的参与者在基线和随访期间大多数MRFs的水平更不利。在糖尿病诊断前3年观察到多种MRFs（包括空腹血糖、替代胰岛素抵抗指标、血脂、收缩压、脉压、心率、丙氨酸转氨酶和C反应蛋白）急剧上升。
我们将糖尿病诊断前3年确定为多种MRFs发生剧烈变化的关键时期。这对于经历多种MRFs突然不良进展的个体的早期监测和及时预防具有重要意义。
