Ducluzeau Pierre Henri, Fauchier Grégoire, Herbert Julien, Semaan Carl, Halimi Jean Michel, Angoulvant Denis, Fauchier Laurent
Service de Médecine Interne, Unité d'Endocrinologie Diabétologie et Nutrition, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France; INRAE, Unité Mixte de Recherche Physiologie de la Reproduction et des Comportements, 37380 Nouzilly, France.
Service de Médecine Interne, Unité d'Endocrinologie Diabétologie et Nutrition, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France.
Diabetes Metab. 2023 May;49(3):101429. doi: 10.1016/j.diabet.2023.101429. Epub 2023 Feb 1.
Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) increase risks of cardiovascular (CV) and renal disease compared with diabetes-free populations. There are only a few studies comparing T1DM and T2DM for the relative risk of these clinical events.
All adult patients hospitalized in French hospitals in 2013 with at least 5 years of follow-up were identified and categorized by their diabetes status. A total of 50,623 patients with T1DM (age 61.4 ± 18.6, 53% male) and 425,207 patients with T2DM (age 68.6 ± 14.3, 55% male) were followed over a median period of 5.3 years (interquartile range: 2.8 - 5.8 years). Prevalence and event rates of myocardial infarction (MI), heart failure (HF), ischemic stroke, chronic kidney disease (CKD), all-cause death and CV death were assessed with age stratification of 10-year intervals. For clinical events during follow-up, we report hazard ratios (HRs) in T1DM relative to T2DM.
The age and sex-adjusted prevalence of CV diseases was higher in T2DM for ages above 40 years whereas the prevalence of CKD was more common in T1DM between ages 18 and 70 years. During 2,033,239 person-years of follow-up, age and sex-adjusted HR event rates comparing T1DM, versus T2DM as reference, showed that MI and HF relative risks were increased above 60 years (1.2 and 1.4 -fold). HR of ischemic stroke did not markedly differ between T1DM and T2DM. Risk of incident CKD was 2.4-fold higher in T1DM above 60 years. All-cause death HR risk was 1.1-fold higher in T1DM after 60 years and the CV death risk was 1.15-fold higher in T1DM between 60 and 69 years compared to T2DM.
Although the crude prevalent burden of CV diseases may be lower in T1DM than in T2DM, patients with T1DM may have a higher risk of incident MI, HF, all-cause death and CV death above 60 years of age, highlighting the need for improved prevention in this population.
与无糖尿病的人群相比，1型糖尿病（T1DM）和2型糖尿病（T2DM）会增加心血管（CV）疾病和肾脏疾病的风险。仅有少数研究比较了T1DM和T2DM发生这些临床事件的相对风险。
确定2013年在法国医院住院且随访至少5年的所有成年患者，并根据其糖尿病状态进行分类。共有50623例T1DM患者（年龄61.4±18.6岁，53%为男性）和425207例T2DM患者（年龄68.6±14.3岁，55%为男性）接受了中位时间为5.3年的随访（四分位间距：2.8 - 5.8年）。按10年间隔进行年龄分层，评估心肌梗死（MI）、心力衰竭（HF）、缺血性卒中、慢性肾脏病（CKD）、全因死亡和CV死亡的患病率及事件发生率。对于随访期间的临床事件，我们报告T1DM相对于T2DM的风险比（HRs）。
40岁以上T2DM患者经年龄和性别调整后的CV疾病患病率更高，而18至70岁T1DM患者的CKD患病率更常见。在2033239人年的随访期间，以T2DM为参照，经年龄和性别调整后的T1DM与T2DM比较的HR事件发生率显示，60岁以上患者MI和HF的相对风险增加（分别为1.2倍和1.4倍）。T1DM和T2DM患者缺血性卒中的HR无明显差异。60岁以上T1DM患者发生CKD的风险高出2.4倍。60岁后T1DM的全因死亡HR风险高出1.1倍，60至69岁T1DM的CV死亡风险比T2DM高出1.15倍。
尽管T1DM中CV疾病的粗患病率负担可能低于T2DM，但60岁以上的T1DM患者发生MI、HF、全因死亡和CV死亡的风险可能更高，这突出表明该人群需要加强预防。
