Department of Diabetes, Endocrine and Metabolic Diseases, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Chiba, Japan.
Clinical Research Support Center, Asahi General Hospital, Asahi, Chiba, Japan.
J Diabetes Investig. 2023 Jan;14(1):37-47. doi: 10.1111/jdi.13918. Epub 2022 Oct 6.
AIMS/INTRODUCTION: The increase in the number of patients with type 2 diabetes mellitus is an important concern worldwide. The goal of this study was to investigate factors involved in the onset of type 2 diabetes mellitus, and sex differences in long-term follow up of people with normal glucose tolerance.
Of 1,309 individuals who underwent screening at our facility in 2004, 748 individuals without diabetes were enrolled. Correlations of metabolic markers including serum adiponectin (APN) with onset of type 2 diabetes mellitus were examined over 15 years in these individuals.
The Kaplan-Meier curve for onset of type 2 diabetes mellitus for 15 years in the decreased APN group was examined. Hazard ratios for the APN concentration for onset of diabetes were 1.78 (95% confidence interval [CI] 1.20-2.63, P = 0.004) in all participants, 1.48 (95% CI 0.96-2.29, P = 0.078) for men and 3.01 (95% CI 1.37-6.59, P = 0.006) for women. During the follow-up period of 15 years, body mass index, estimated glomerular filtration rate, fatty liver, C-reactive protein and alanine aminotransferase in men were significant in univariate analysis, but only estimated glomerular filtration rate and fatty liver were significantly related to onset of type 2 diabetes mellitus in multivariate analysis. In women, body mass index, systolic blood pressure, triglyceride, fatty liver and APN were significant in univariate analysis, and APN was the only significant risk factor in multivariate analysis (P < 0.05).
There are differences between men and women with regard to targets for intervention to prevent the onset of type 2 diabetes mellitus. Individuals requiring intensive intervention should be selected with this finding to maximize the use of limited social and economic resources.
目的/引言：2 型糖尿病患者人数的增加是全球关注的一个重要问题。本研究的目的是探讨 2 型糖尿病发病的相关因素，以及糖耐量正常人群的长期随访中存在的性别差异。
在我们 2004 年的筛查中，共有 1309 人参加，其中 748 人没有糖尿病。在这些人中，经过 15 年的时间，对包括血清脂联素（APN）在内的代谢标志物与 2 型糖尿病发病的相关性进行了研究。
对 15 年时 APN 降低组 2 型糖尿病发病的 Kaplan-Meier 曲线进行了检查。APN 浓度与糖尿病发病的风险比为 1.78（95%置信区间 [CI] 1.20-2.63，P=0.004），在所有参与者中，1.48（95%CI 0.96-2.29，P=0.078），男性为 3.01（95%CI 1.37-6.59，P=0.006），女性为 3.01（95%CI 1.37-6.59，P=0.006）。在 15 年的随访期间，男性的体重指数、估计肾小球滤过率、脂肪肝、C 反应蛋白和丙氨酸氨基转移酶在单变量分析中是显著的，但只有估计肾小球滤过率和脂肪肝在多变量分析中与 2 型糖尿病的发病有关。在女性中，体重指数、收缩压、甘油三酯、脂肪肝和 APN 在单变量分析中是显著的，而 APN 是多变量分析中唯一显著的危险因素（P<0.05）。
在预防 2 型糖尿病发病的干预目标方面，男女之间存在差异。应该根据这一发现选择需要强化干预的个体，以最大限度地利用有限的社会和经济资源。
