诗里拉吉医院（一家三级转诊中心）年轻起病的1型和2型糖尿病患者的临床特征、血糖控制及微血管并发症比较
Clinical Characteristics, Glycemic Control, and Microvascular Complications Compared Between Young-Onset Type 1 and Type 2 Diabetes Patients at Siriraj Hospital - A Tertiary Referral Center.
作者信息
Preechasuk Lukana, Tantasuwan Suchavadee, Likitmaskul Supawadee, Santiprabhob Jeerunda, Lertbannaphong Ornsuda, Plengvidhya Nattachet, Tangjittipokin Watip, Nitiyanant Wannee, Lertwattanarak Raweewan
机构信息
Siriraj Diabetes Center of Excellence, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Diabetes Metab Syndr Obes. 2022 May 2;15:1375-1387. doi: 10.2147/DMSO.S354787. eCollection 2022.
PURPOSE
This study aimed to investigate the clinical characteristics, glycemic control, and microvascular complications compared between young-onset type 1 (T1DM) and type 2 diabetes (T2DM) patients at Siriraj Hospital.
PATIENTS AND METHODS
We collected demographic, clinical, glycemic control, and microvascular complication data of young-onset (onset <30 years of age) T1DM and T2DM patients at our center using February 2019-December 2020 data from the Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN).
RESULTS
Of 396 patients, 76% had T1DM and 24% had T2DM. At diagnosis, T1DM were significantly younger (9.7±5.4 vs 16.9±6.4 years, <0.001), had a lower body mass index (17.2±4.1 vs 30.8±7.9 kg/m, <0.001), higher prevalence of diabetic ketoacidosis (DKA) (66.1% vs 13.7%, <0.001), and higher HbA level (12.8±2.6% vs 10.9±3.1%, =0.002) compared to T2DM. Regarding glycemic control, the mean HbA at registry enrollment did not differ between groups (T1DM 8.3±1.8% vs T2DM 8.1±2.2%, =0.303), but T1DM achieved HbA <7% significantly less than T2DM (19.3% vs 47.8%, <0.001). T1DM showed deterioration of glycemic control during 10-20 years of age, and gradually improved during 20-30 years of age, whereas patients with T2DM showed progressive worsening of glycemic control over time. Concerning microvascular complications, the prevalence of diabetic retinopathy (10.6% vs 9%, =0.92) and diabetic neuropathy (3.4% vs 5.5%, =0.514) between T1DM and T2DM was not significantly different. However, T2DM had a significantly higher prevalence of diabetic nephropathy (T1DM 10.1% vs T2DM 40.2%, <0.001) that developed within a significantly shorter duration of diabetes (T1DM 11.0±6.8 vs T2DM 4.3±5.1 years, <0.001) compared to T1DM.
CONCLUSION
T1DM had a significantly high prevalence of DKA at presentation, and most T1DM did not achieve the glycemic target, especially during adolescence. T2DM had a significantly higher prevalence of diabetic nephropathy that developed within a shorter duration of diabetes compared to T1DM.
目的
本研究旨在比较诗里拉吉医院年轻发病的1型糖尿病（T1DM）和2型糖尿病（T2DM）患者的临床特征、血糖控制及微血管并发症情况。
患者与方法
我们利用泰国1型糖尿病及30岁前诊断的糖尿病登记、护理与网络（T1DDAR CN）中2019年2月至2020年12月的数据，收集了本中心年轻发病（发病年龄<30岁）的T1DM和T2DM患者的人口统计学、临床、血糖控制及微血管并发症数据。
结果
在396例患者中，76%为T1DM，24%为T2DM。诊断时，T1DM患者明显更年轻（9.7±5.4岁对16.9±6.4岁，<0.001），体重指数更低（17.2±4.1对30.8±7.9kg/m²，<0.001），糖尿病酮症酸中毒（DKA）患病率更高（66.1%对13.7%，<0.001），糖化血红蛋白（HbA）水平更高（12.8±2.6%对10.9±3.1%，=0.002）。关于血糖控制，登记入组时两组的平均HbA无差异（T1DM 8.3±1.8%对T2DM 8.1±2.2%，=0.303），但T1DM患者HbA<7%的比例显著低于T2DM（19.3%对47.8%，<0.001）。T1DM患者在10 - 20岁时血糖控制恶化，在20 - 30岁时逐渐改善，而T2DM患者的血糖控制随时间逐渐恶化。关于微血管并发症，T1DM和T2DM之间糖尿病视网膜病变（10.6%对9%，=0.92）和糖尿病神经病变（3.4%对5.5%，=0.514）的患病率无显著差异。然而，T2DM的糖尿病肾病患病率显著更高（T1DM 10.1%对T2DM 40.2%，<0.001），且糖尿病肾病在糖尿病病程显著更短的时间内发生（T1DM 11.0±6.8年对T2DM 4.3±5.1年，<0.001）。
结论
T1DM患者就诊时DKA患病率显著较高，大多数T1DM患者未达到血糖目标，尤其是在青春期。与T1DM相比，T2DM的糖尿病肾病患病率显著更高，且在糖尿病病程较短的时间内发生。
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