Hou Can, Yang Huazhen, Qu Yuanyuan, Chen Wenwen, Zeng Yu, Hu Yao, Narayan K M Venkat, Song Huan, Li Dong
West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, China.
Emory Global Diabetes Research Center (EGDRC), Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Precis Clin Med. 2022 Jun 6;5(2):pbac015. doi: 10.1093/pcmedi/pbac015. eCollection 2022 Jun.
Although cumulating evidence has suggested that early-onset type 2 diabetes mellitus (T2DM) conferred on patients a broader tendency for complications beyond vascular ones, a comprehensive analysis of patterns of complications across all relevant systems is currently lacking.
We prospectively studied 1 777 early-onset (age at diagnosis ≤ 45 years) and 35 889 late-onset (>45 years) T2DM patients with matched unexposed individuals from the UK Biobank. Diabetes-specific and -related complications were examined using phenome-wide association analysis, with patterns identified by comorbidity network analysis. We also evaluated the effect of lifestyle modifications and glycemic control on complication development.
The median follow-up times for early-onset and late-onset T2DM patients were 17.83 and 9.39 years, respectively. Compared to late-onset T2DM patients, patients with early-onset T2DM faced a significantly higher relative risk of developing subsequent complications that primarily affected sense organs [hazard ratio (HR) 3.46 vs. 1.72], the endocrine/metabolic system (HR 3.08 vs. 2.01), and the neurological system (HR 2.70 vs. 1.81). Despite large similarities in comorbidity patterns, a more complex and well-connected network was observed for early-onset T2DM. Furthermore, while patients with early-onset T2DM got fewer benefits (12.67% reduction in pooled HR for all studied complications) through fair glycemic control (median HbA ≤ 53 mmol/mol) compared to late-onset T2DM patients (18.01% reduction), they seemed to benefit more from favorable lifestyles, including weight control, healthy diet, and adequate physical activity.
Our analyses reveal that early-onset T2DM is an aggressive disease resulting in more complex complication networks than late-onset T2DM. Aggressive glucose-lowering intervention, complemented by lifestyle modifications, are feasible strategies for controlling early-onset T2DM-related complications.
尽管越来越多的证据表明，早发型2型糖尿病（T2DM）使患者面临比血管并发症更广泛的并发症倾向，但目前缺乏对所有相关系统并发症模式的全面分析。
我们对来自英国生物银行的1777例早发型（诊断时年龄≤45岁）和35889例晚发型（>45岁）T2DM患者以及匹配的未患糖尿病个体进行了前瞻性研究。使用全表型关联分析检查糖尿病特异性和相关并发症，并通过共病网络分析确定模式。我们还评估了生活方式改变和血糖控制对并发症发生的影响。
早发型和晚发型T2DM患者的中位随访时间分别为17.83年和9.39年。与晚发型T2DM患者相比，早发型T2DM患者发生主要影响感觉器官的后续并发症的相对风险显著更高[风险比（HR）3.46对1.72]、内分泌/代谢系统（HR 3.08对2.01）和神经系统（HR 2.70对1.81）。尽管共病模式有很大相似性，但早发型T2DM的共病网络更复杂且连接更紧密。此外，与晚发型T2DM患者（降低18.01%）相比，早发型T2DM患者通过良好的血糖控制（中位糖化血红蛋白≤53 mmol/mol）获得的益处较少（所有研究并发症的合并HR降低12.67%），但他们似乎从包括体重控制、健康饮食和适当体育活动在内的良好生活方式中获益更多。
我们的分析表明，早发型T2DM是一种侵袭性疾病，导致的并发症网络比晚发型T2DM更复杂。积极的降糖干预辅以生活方式改变是控制早发型T2DM相关并发症的可行策略。
