Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China.
Front Endocrinol (Lausanne). 2024 May 13;15:1369908. doi: 10.3389/fendo.2024.1369908. eCollection 2024.
A phenomenon known as legacy effect was observed that poor glycemic control at early stage of patients with newly-diagnosed type 2 diabetes (T2D) increases the risk of subsequent cardiovascular diseases (CVD). Early use of some novel anti-hyperglycemic agents, such as sodium-glucose transport protein 2 inhibitors (SGLT-2i), may attenuate this effect, but the evidence is limited.
Two retrospective cohorts of newly diagnosed T2D patients from 2010-2023 were assembled using the Yinzhou Regional Health Care Database (YRHCD) with different definitions of the early exposure period - the 1-year exposure cohort and 2-year exposure cohort, which were comprised of subjects who had HbA1c measurement data within 1 year and 2 years after their T2D diagnosis, respectively. Using Cox proportional hazards models, we examined the association between high HbA1c level (HbA1c>7%) during the early exposure period and the risk of subsequent CVD. This analysis was performed in the overall cohort and three subpopulations with different treatments during the early exposure period, including patients initiating SGLT-2i or glucagon-like peptide-1 receptor agonists (GLP-1RA), patients using dipeptidyl peptidase-4 inhibitors (DPP-4i), and patients without using SGLT-2i, GLP-1RA, and DPP-4i. Besides, subgroup analyses were performed by stratifying patients into age <55 and ≥55 years.
A total of 21,477 and 22,493 patients with newly diagnosed T2D were included in the two final cohorts. Compared with patients with mean HbA1c ≤ 7% during the early exposure period, those with HbA1c>7% had higher risks of incident CVD, with a HR of 1.165 (95%CI, 1.056-1.285) and 1.143 (95%CI, 1.044-1.252) in 1-year and 2-year exposure period cohort. Compared to non-users, in patients initiating SGLT-2i/GLP-1RA within 1 or 2 years after T2D diagnosis, higher HbA1c level at baseline was not associated with CVD in both two cohorts. In subgroup analyses, results were generally consistent with the main analysis.
Poor glycemic control in the early stage of T2D increased later CVD risk in Chinese adults with newly diagnosed T2D. Compared to non-users, this association was smaller and non-significant in patients receiving SGLT-2i/GLP-1RA during the early stage of T2D, indicating early use of these drugs may have the potential to mitigate legacy effects of hyperglycemia.
观察到一种称为遗留效应的现象，即新诊断的 2 型糖尿病（T2D）患者早期血糖控制不佳会增加随后发生心血管疾病（CVD）的风险。早期使用一些新型抗高血糖药物，如钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i），可能会减弱这种效应，但证据有限。
使用鄞州区卫生保健数据库（YRHCD），根据早期暴露期的不同定义，即 1 年暴露队列和 2 年暴露队列，组建了 2010 年至 2023 年期间新诊断的 T2D 患者的两个回顾性队列。队列中包含在 T2D 诊断后 1 年和 2 年内有 HbA1c 测量数据的患者。使用 Cox 比例风险模型，我们研究了早期暴露期内高 HbA1c 水平（HbA1c>7%）与随后 CVD 风险之间的关联。这项分析在整个队列和早期暴露期接受不同治疗的三个亚群中进行，包括开始使用 SGLT-2i 或胰高血糖素样肽-1 受体激动剂（GLP-1RA）、使用二肽基肽酶-4 抑制剂（DPP-4i）和未使用 SGLT-2i、GLP-1RA 和 DPP-4i 的患者。此外，还按年龄<55 岁和≥55 岁进行了亚组分析。
共有 21477 名和 22493 名新诊断的 T2D 患者分别纳入了两个最终队列。与早期暴露期 HbA1c≤7%的患者相比，HbA1c>7%的患者发生 CVD 的风险更高，1 年和 2 年暴露期队列的 HR 分别为 1.165（95%CI，1.056-1.285）和 1.143（95%CI，1.044-1.252）。与非使用者相比，在 T2D 诊断后 1 或 2 年内开始使用 SGLT-2i/GLP-1RA 的患者，基线时较高的 HbA1c 水平与两个队列中的 CVD 均无关。在亚组分析中，结果与主要分析基本一致。
T2D 早期血糖控制不佳会增加中国新诊断 T2D 成年人的后期 CVD 风险。与非使用者相比，在 T2D 早期接受 SGLT-2i/GLP-1RA 治疗的患者，这种关联较小且无统计学意义，表明早期使用这些药物可能有减轻高血糖遗留效应的潜力。
