Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
Diabetes Care. 2023 Sep 1;46(9):1659-1667. doi: 10.2337/dc23-0343.
To examine the role of glycemic measures performed during childhood in predicting future diabetes-related nephropathy and retinopathy in a high-risk indigenous American cohort.
We studied associations between glycated hemoglobin (HbA1c) and 2-h plasma glucose (PG), measured during childhood (age 5 to <20 years) in a longitudinal observational study of diabetes and its complications (1965-2007), and future albuminuria (albumin creatinine ratio [ACR] ≥30 mg/g), severe albuminuria (ACR ≥300 mg/g), and retinopathy (at least one microaneurysm or hemorrhage or proliferative retinopathy on direct ophthalmoscopy). Areas under the receiver operating characteristic curve (AUCs) for childhood glycemic measures when predicting nephropathy and retinopathy were compared.
Higher baseline levels of HbA1c and 2-h PG significantly increased the risk of future severe albuminuria (HbA1c: hazard ratio [HR] 1.45 per %; 95% CI 1.02-2.05 and 2-h PG: HR 1.21 per mmol/L; 95% CI 1.16-1.27). When categorized by baseline HbA1c, children with prediabetes had a higher incidence of albuminuria (29.7 cases per 1,000 person-years [PY]), severe albuminuria (3.8 cases per 1,000 PY), and retinopathy (7.1 cases per 1,000 PY) than children with normal HbA1c levels (23.8, 2.4, and 1.7 cases per 1,000 PY, respectively); children with diabetes at baseline had the highest incidence of the three complications. No significant differences were observed between AUCs for models with HbA1c, 2-h PG, and fasting PG when predicting albuminuria, severe albuminuria, or retinopathy.
In this study, higher glycemia levels ascertained by HbA1c and 2-h PG during childhood were associated with future microvascular complications; this demonstrates the potential utility of screening tests performed in high-risk children in predicting long-term health outcomes.
在一个高危的美洲原住民队列中，研究儿童时期的血糖测量值在预测未来糖尿病相关肾病和视网膜病变中的作用。
我们研究了在糖尿病及其并发症的纵向观察研究（1965-2007 年）中，儿童时期（5 岁至<20 岁）测量的糖化血红蛋白（HbA1c）和 2 小时血糖（PG）与未来白蛋白尿（白蛋白肌酐比 [ACR]≥30mg/g）、严重白蛋白尿（ACR≥300mg/g）和视网膜病变（直接检眼镜下至少一个微动脉瘤或出血或增殖性视网膜病变）之间的关联。比较了儿童期血糖测量值预测肾病和视网膜病变的受试者工作特征曲线（ROC）下面积（AUC）。
基线 HbA1c 和 2-h PG 水平升高显著增加了未来严重白蛋白尿的风险（HbA1c：每%的危险比 [HR]1.45；95%CI 1.02-2.05 和 2-h PG：每 mmol/L 的 HR 1.21；95%CI 1.16-1.27）。根据基线 HbA1c 分类，患有糖尿病前期的儿童发生白蛋白尿（29.7 例/1000 人年 [PY]）、严重白蛋白尿（3.8 例/1000 PY）和视网膜病变（7.1 例/1000 PY）的发生率高于 HbA1c 水平正常的儿童（分别为 23.8、2.4 和 1.7 例/1000 PY）；基线患有糖尿病的儿童发生这三种并发症的发生率最高。在预测白蛋白尿、严重白蛋白尿或视网膜病变时，HbA1c、2-h PG 和空腹 PG 模型的 AUC 之间没有显著差异。
在这项研究中，儿童时期通过 HbA1c 和 2-h PG 确定的较高血糖水平与未来的微血管并发症有关；这表明在高危儿童中进行筛查测试预测长期健康结局具有潜在的效用。
