Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.
Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China.
Diabetes Obes Metab. 2023 Sep;25(9):2575-2585. doi: 10.1111/dom.15142. Epub 2023 May 29.
To investigate the associations of diabetes, prediabetes and diabetes duration with chronic obstructive pulmonary disease (COPD) risk and survival in the UK Biobank.
We conducted a prospective analysis among 452 680 participants without COPD at baseline using UK Biobank data. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox regression models. The dose-response relationship was explored using restricted cubic splines. A separate survival analysis was conducted for 12 595 patients with incident COPD.
Over a median follow-up of 12.3 years, 12 595 cases of COPD were documented. Compared with the reference group, those with prediabetes and diabetes were associated with an 18% (HR 1.18 [95% CI: 1.13-1.24]) and 35% (HR 1.35 [95% CI: 1.24-1.47]) higher risk of COPD, respectively. Diabetes duration was associated with COPD risk, with multivariable HRs (95% CIs) of 1.23 (1.05-1.44), 1.20 (1.04-1.39) and 1.18 (1.01-1.37) for diabetes duration of 7 years or longer, 3 to less than 7 years, and 1 to less than 3 years versus less than 1 year, respectively. Dose-response analysis revealed a non-linear relationship between diabetes duration and COPD risk. Regarding COPD survival, COPD patients with prediabetes and diabetes had a 9% (HR 1.09 [95% CI: 1.00-1.19]) and 21% (HR 1.21 [95% CI: 1.05-1.41]) higher risk of overall death, respectively. Compared with the cases with a diabetes duration of less than 1 year, those with a diabetes duration of 7 years or longer were associated with a 46% higher risk of overall death (HR 1.46 [95% CI: 1.11-1.92]).
Our findings indicate that diabetes, prediabetes and a longer diabetes duration are associated with a higher risk of and worse survival for COPD. Future studies are warranted to determine the optimal way of diabetes control that might reduce COPD risk.
在英国生物库中,研究糖尿病、糖尿病前期和糖尿病病程与慢性阻塞性肺疾病(COPD)风险和生存的关系。
我们使用英国生物库的数据,对基线时无 COPD 的 452680 名参与者进行了前瞻性分析。采用 Cox 回归模型估计多变量调整后的风险比(HR)和 95%置信区间(CI)。采用限制性立方样条法探讨剂量-反应关系。对 12595 例新发 COPD 患者进行了单独的生存分析。
在中位随访 12.3 年期间,共记录了 12595 例 COPD 病例。与参考组相比,糖尿病前期和糖尿病患者患 COPD 的风险分别增加了 18%(HR 1.18 [95%CI:1.13-1.24])和 35%(HR 1.35 [95%CI:1.24-1.47])。糖尿病病程与 COPD 风险相关,病程 7 年或以上、3 至少于 7 年和 1 至少于 3 年的多变量 HR(95%CI)分别为 1.23(1.05-1.44)、1.20(1.04-1.39)和 1.18(1.01-1.37),而病程少于 1 年的 HR 为 1.00。与病程少于 1 年的患者相比,病程 7 年或更长的患者全因死亡风险增加 46%(HR 1.46 [95%CI:1.11-1.92])。
我们的研究结果表明,糖尿病、糖尿病前期和较长的糖尿病病程与 COPD 的风险增加和预后较差相关。需要进一步的研究来确定可能降低 COPD 风险的糖尿病控制的最佳方法。