糖尿病大血管并发症与糖尿病微血管并发症风险增加相关：英国生物库中 1518 例 1 型糖尿病患者和 20802 例 2 型糖尿病患者的前瞻性研究。
Diabetes-Related Macrovascular Complications Are Associated With an Increased Risk of Diabetic Microvascular Complications: A Prospective Study of 1518 Patients With Type 1 Diabetes and 20 802 Patients With Type 2 Diabetes in the UK Biobank.
机构信息
Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai People's Republic of China.
National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai People's Republic of China.
出版信息
J Am Heart Assoc. 2024 Jun 4;13(11):e032626. doi: 10.1161/JAHA.123.032626. Epub 2024 May 31.
BACKGROUND
Diabetic vascular complications share common pathophysiological mechanisms, but the relationship between diabetes-related macrovascular complications (MacroVCs) and incident diabetic microvascular complications remains unclear. We aimed to investigate the impact of MacroVCs on the risk of microvascular complications.
METHODS AND RESULTS
There were 1518 participants with type 1 diabetes (T1D) and 20 802 participants with type 2 diabetes from the UK Biobank included in this longitudinal cohort study. MacroVCs were defined by the presence of macrovascular diseases diagnosed after diabetes at recruitment, including coronary heart disease, peripheral artery disease, stroke, and ≥2 MacroVCs. The primary outcome was incident microvascular complications, a composite of diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy. During a median (interquartile range) follow-up of 11.61 (5.84-13.12) years and 12.2 (9.50-13.18) years, 596 (39.3%) and 4113 (19.8%) participants developed a primary outcome in T1D and type 2 diabetes, respectively. After full adjustment for conventional risk factors, Cox regression models showed significant associations between individual as well as cumulative MacroVCs and the primary outcome, except for coronary heart disease in T1D (T1D: diabetes coronary heart disease: 1.25 [0.98-1.60]; diabetes peripheral artery disease: 3.00 [1.86-4.84]; diabetes stroke: 1.71 [1.08-2.72]; ≥2: 2.57 [1.66-3.99]; type 2 diabetes: diabetes coronary heart disease: 1.59 [1.38-1.82]; diabetes peripheral artery disease: 1.60 [1.01-2.54]; diabetes stroke: 1.50 [1.13-1.99]; ≥2: 2.66 [1.92-3.68]). Subgroup analysis showed that strict glycemic (glycated hemoglobin <6.5%) and blood pressure (<140/90 mm Hg) control attenuated the association.
CONCLUSIONS
Individual and cumulative MacroVCs confer significant risk of incident microvascular complications in patients with T1D and type 2 diabetes. Our results may facilitate cost-effective high-risk population identification and development of precise prevention strategies.
背景
糖尿病血管并发症具有共同的病理生理机制，但糖尿病相关大血管并发症（MacroVCs）与糖尿病微血管并发症的发生之间的关系尚不清楚。我们旨在研究 MacroVCs 对微血管并发症风险的影响。
方法和结果
本纵向队列研究纳入了来自英国生物库的 1518 名 1 型糖尿病（T1D）患者和 20802 名 2 型糖尿病患者。MacroVCs 的定义是在招募时患有糖尿病后诊断出的大血管疾病，包括冠心病、外周动脉疾病、中风和≥2 种 MacroVCs。主要结局是新发微血管并发症，包括糖尿病视网膜病变、糖尿病肾病和糖尿病神经病变。在中位（四分位间距）随访 11.61（5.84-13.12）年和 12.2（9.50-13.18）年后，分别有 596（39.3%）和 4113（19.8%）名参与者在 T1D 和 2 型糖尿病中发生了主要结局。在充分调整了常规危险因素后，Cox 回归模型显示，个体和累积 MacroVCs 与主要结局之间存在显著关联，但 T1D 中的冠心病除外（T1D：糖尿病冠心病：1.25 [0.98-1.60]；糖尿病外周动脉疾病：3.00 [1.86-4.84]；糖尿病中风：1.71 [1.08-2.72]；≥2 种：2.57 [1.66-3.99]；2 型糖尿病：糖尿病冠心病：1.59 [1.38-1.82]；糖尿病外周动脉疾病：1.60 [1.01-2.54]；糖尿病中风：1.50 [1.13-1.99]；≥2 种：2.66 [1.92-3.68]）。亚组分析表明，严格的血糖（糖化血红蛋白<6.5%）和血压（<140/90mmHg）控制减弱了这种关联。
结论
个体和累积的 MacroVCs 显著增加了 T1D 和 2 型糖尿病患者发生微血管并发症的风险。我们的结果可能有助于确定具有成本效益的高危人群，并制定精确的预防策略。
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