Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
JAMA Netw Open. 2023 Jun 1;6(6):e2319038. doi: 10.1001/jamanetworkopen.2023.19038.
Spouses share common socioeconomic, environmental, and lifestyle factors, and multiple studies have found that spousal diabetes status was associated with diabetes prevalence. But the association of spousal diabetes status and ideal cardiovascular health metrics (ICVHMs) assessed by the American Heart Association's Life's Essential 8 measures with incident diabetes has not been comprehensively characterized, especially in large-scale cohort studies.
To explore the association of spousal diabetes status and cardiovascular health metrics with risk of incident diabetes in Chinese adults.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included individuals in the China Cardiovascular Disease and Cancer Cohort without diabetes who underwent baseline and follow-up glucose measurements and had spouses with baseline glucose measurements. The data were collected in January 2011 to December 2012 and March 2014 to December 2016. The spousal study had a mean (SD) follow-up of 3.6 (0.9) years (median [IQR], 3.2 [2.9-4.5] years). Statistical analysis was performed from July to November 2022.
Spousal diabetes status was diagnosed according to the 2010 American Diabetes Association (ADA) criteria. All participants provided detailed clinical, sociodemographic, and lifestyle information included in cardiovascular health metrics.
Incident diabetes, diagnosed according to 2010 ADA criteria.
Overall, 34 821 individuals were included, with a mean (SD) age of 56.4 (8.3) years and 16 699 (48.0%) male participants. Spousal diabetes diagnosis was associated with an increased risk of incident diabetes (hazard ratio [HR], 1.15; 95% CI, 1.03-1.30). Furthermore, participants whose spouses had uncontrolled glycated hemoglobin (HbA1c) had a higher risk of diabetes (HR, 1.20; 95% CI, 1.04-1.39) but the risk of diabetes in participants whose spouses had controlled HbA1c did not increase significantly (HR, 1.10; 95% CI, 0.92-1.30). Moreover, this association varied with composite cardiovascular health status. Diabetes risk in individuals who had poor cardiovascular health status (<4 ICVHMs) was associated with spousal diabetes status (3 ICVHMs: HR, 1.50; 95% CI, 1.15-1.97), while diabetes risk in individuals who had intermediate to ideal cardiovascular health status (≥4 ICVHMs) was not associated with it (4 ICVHMs: HR, 1.01; 95% CI, 0.69-1.50).
In this study, spousal diabetes diagnosis with uncontrolled HbA1c level was associated with increased risk of incident diabetes, but strict management of spousal HbA1c level and improving ICVHM profiles may attenuate the association of spousal diabetes status with diabetes risk. These findings suggest the potential benefit of couple-based lifestyle or pharmaceutical interventions for diabetes.
配偶共享共同的社会经济、环境和生活方式因素，多项研究发现配偶的糖尿病状况与糖尿病患病率有关。但是，配偶的糖尿病状况与美国心脏协会的生命基本 8 项措施评估的理想心血管健康指标（ICVHMs）与糖尿病发病风险之间的关联尚未得到全面描述，特别是在大规模队列研究中。
探讨中国成年人配偶的糖尿病状况和心血管健康指标与糖尿病发病风险的关系。
设计、地点和参与者：这项队列研究纳入了中国心血管疾病与癌症队列中无糖尿病的个体，这些个体接受了基线和随访的血糖测量，并在基线时测量了配偶的血糖。数据收集于 2011 年 1 月至 2012 年 12 月和 2014 年 3 月至 2016 年 12 月。配偶研究的平均（SD）随访时间为 3.6（0.9）年（中位数[IQR]，3.2[2.9-4.5]年）。统计分析于 2022 年 7 月至 11 月进行。
根据 2010 年美国糖尿病协会（ADA）标准诊断配偶的糖尿病状况。所有参与者均提供了包括心血管健康指标在内的详细临床、社会人口统计学和生活方式信息。
根据 2010 年 ADA 标准诊断的新发糖尿病。
共有 34821 人纳入研究，平均（SD）年龄为 56.4（8.3）岁，16699 人（48.0%）为男性。配偶的糖尿病诊断与新发糖尿病风险增加相关（风险比[HR]，1.15；95%CI，1.03-1.30）。此外，配偶糖化血红蛋白（HbA1c）控制不佳的参与者患糖尿病的风险更高（HR，1.20；95%CI，1.04-1.39），但 HbA1c 控制良好的配偶的糖尿病发病风险没有显著增加（HR，1.10；95%CI，0.92-1.30）。此外，这种关联随复合心血管健康状况而变化。心血管健康状况较差（<4 项 ICVHMs）的个体的糖尿病风险与配偶的糖尿病状况相关（3 项 ICVHMs：HR，1.50；95%CI，1.15-1.97），而心血管健康状况处于中等至理想水平（≥4 项 ICVHMs）的个体的糖尿病风险则与配偶的糖尿病状况无关（4 项 ICVHMs：HR，1.01；95%CI，0.69-1.50）。
在这项研究中，伴有未控制的 HbA1c 水平的配偶的糖尿病诊断与新发糖尿病风险增加有关，但严格控制配偶的 HbA1c 水平和改善 ICVHM 特征可能会减轻配偶的糖尿病状况与糖尿病风险之间的关联。这些发现表明，基于伴侣的生活方式或药物干预可能对糖尿病有潜在益处。
