美国糖尿病工作年龄和老年成年人的代谢谱、社会经济地位及糖尿病视网膜病变差异：1999 - 2018年美国国家健康与营养检查调查结果
The differences of metabolic profiles, socioeconomic status and diabetic retinopathy in U.S. working-age and elderly adults with diabetes: results from NHANES 1999-2018.
作者信息
Li Bo, Cheng Xiaoyun, Huang Yikeng, Zhou Chuandi, Gu Chufeng, Zhu Xinyu, Li Chenxin, Ma Mingming, Fan Ying, Xu Xun, Zheng Zhi, Chen Haibing, Zhao Shuzhi
机构信息
Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, 100 Haining Road, Hongkou District, Shanghai, 200080, China.
Department of Ophthalmology, the Fourth Affiliated Hospital of Soochow University, 9 Chongwen Road, Suzhou Industrial Park, Suzhou, Jiangsu Province, 215123, China.
出版信息
Acta Diabetol. 2025 Jan;62(1):25-34. doi: 10.1007/s00592-024-02328-8. Epub 2024 Aug 5.
AIMS
Controlled metabolic factors and socioeconomic status (SES) was crucial for prevention of diabetic retinopathy (DR). The study aims to assess the metabolic factors control and SES among working-age adults (18-64 years) with diabetes compared to older adults (65 years and older).
METHODS
Totals of 6738 participants with self-reported diagnosed diabetes from National Health and Nutrition Examination Survey were included, of whom 3482 were working-age and 3256 were elderly. The prevalence of DR, metabolic factors control, and the impact of SES and diabetic duration on DR was estimated. Subgroup analysis among working-age adults was employed across different diabetic duration and SES level.
RESULTS
The prevalence of DR was 20.8% among working-age adults and 20.6% in elderly adults. Further, working-age adults possessed suboptimal control on glycemia (median HbA1c: 7.0% vs. 6.8%, p < 0.001) and lipids (Low-density lipoprotein < 100 mg/dL: 46.4% vs. 63.5%, p < 0.001), but better blood pressure control (< 130/80 mmHg: 53.5% vs. 37.5%, p < 0.001) compared to the elderly, judging based on age-specific control targets. Prolonged diabetic duration didn't improve glycemic and composite factors control. SES like education and income impacted metabolic factors control and adults with higher SES were more likely to control well. Diabetic duration was a significant risk factor (OR = 4.006, 95%CI= (2.752,5.832), p < 0.001) while higher income (OR = 0.590, 95%CI= (0.421,0.826), p = 0.002) and educational level (OR = 0.637, 95%CI= (0.457,0.889), p = 0.008) were protective against DR.
CONCLUSIONS
Working-age adults with diabetes demonstrate suboptimal metabolic profile control, especially glycemia and lipids. Additional efforts are needed to improve metabolic factor control and reduce DR risk, particularly for those with longer diabetes duration, less education, and lower incomes.
目的
控制代谢因素和社会经济地位（SES）对于预防糖尿病视网膜病变（DR）至关重要。本研究旨在评估糖尿病在职成年人（18 - 64岁）与老年人（65岁及以上）之间的代谢因素控制情况和社会经济地位。
方法
纳入了来自国家健康与营养检查调查的6738名自我报告诊断为糖尿病的参与者，其中3482名是在职成年人，3256名是老年人。估计了糖尿病视网膜病变的患病率、代谢因素控制情况，以及社会经济地位和糖尿病病程对糖尿病视网膜病变的影响。对在职成年人在不同糖尿病病程和社会经济地位水平下进行了亚组分析。
结果
在职成年人中糖尿病视网膜病变的患病率为20.8%，老年人中为20.6%。此外，根据年龄特异性控制目标判断，在职成年人在血糖（糖化血红蛋白中位数：7.0%对6.8%，p < 0.001）和血脂（低密度脂蛋白<100mg/dL：46.4%对63.5%，p < 0.001）控制方面欠佳，但血压控制情况较好（<130/80mmHg：53.5%对37.5%，p < 0.001）。糖尿病病程延长并未改善血糖和综合因素的控制。教育和收入等社会经济地位影响代谢因素控制，社会经济地位较高的成年人更有可能控制良好。糖尿病病程是一个显著的危险因素（OR = 4.006，95%CI =（2.752，5.832），p < 0.001），而较高的收入（OR = 0.590，95%CI =（0.421，0.826），p = 0.002）和教育水平（OR = 0.637，95%CI =（0.457，0.889），p = 0.008）对糖尿病视网膜病变有保护作用。
结论
患有糖尿病的在职成年人表现出欠佳的代谢状况控制，尤其是血糖和血脂。需要做出更多努力来改善代谢因素控制并降低糖尿病视网膜病变风险，特别是对于糖尿病病程较长、教育程度较低和收入较低的人群。
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