与晚发型相比，早发型 2 型糖尿病：对英国前瞻性糖尿病研究（UKPDS）长达 30 年随访的分析（UKPDS92）。
Younger-onset compared with later-onset type 2 diabetes: an analysis of the UK Prospective Diabetes Study (UKPDS) with up to 30 years of follow-up (UKPDS 92).
机构信息
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
出版信息
Lancet Diabetes Endocrinol. 2024 Dec;12(12):904-914. doi: 10.1016/S2213-8587(24)00242-0. Epub 2024 Oct 23.
BACKGROUND
Younger-onset type 2 diabetes is associated with accelerated complications. We assessed whether complications and mortality rates differed for younger age compared with older age at diagnosis over 30 years of follow-up.
METHODS
In this study, we used data from the UKPDS, collected between 1977 and 2007, of participants aged 25-65 years with newly diagnosed type 2 diabetes with younger-onset (younger than 40 years) or later-onset (40 years or older), and without diabetes autoantibodies. We analysed standardised mortality ratios (SMR) using UK general population data, and incidence rates of prespecified outcomes by 10-year age intervals at diagnosis.
FINDINGS
Of 4550 participants testing negative to all measured autoantibodies, 429 (9·4%) had younger-onset type 2 diabetes. 2704 (59·4%) were male, and mean HbA was 76 mmol/mol (SD 24·6). The median follow-up was 17·5 years (IQR 12·7-20·8). SMR for younger-onset type 2 diabetes was higher (3·72 [95% CI 2·98-4·64]) compared with later-onset type 2 diabetes (1·54 [1·47-1·61]). The incidence rate was higher for all outcomes in later-onset type 2 diabetes, except for microvascular disease (younger-onset 14·5 (11·9-17·7) vs later-onset 12·1 (11·3-13·0) per 1000 person-years). However, at any given age, the 5-year incidence of any diabetes-related endpoint, all-cause mortality, microvascular disease, and myocardial infarction was higher with younger age at diagnosis. Annual mean HbA was higher in the first 20 years in younger-onset compared with later-onset type 2 diabetes. Among participants randomised to intensive versus conventional glycaemic control, we observed no interactions by subgroup of younger-onset versus later-onset type 2 diabetes for any outcome.
INTERPRETATION
The risk of dying relative to the general population is even greater for people diagnosed with type 2 diabetes at younger ages. The increased risk of complications and poorer glycaemic control in younger-onset type 2 diabetes calls for the development of services to identify and manage these individuals.
FUNDING
National Institute of Health and Care Research's Biomedical Research Centre.
背景
年轻起病的 2 型糖尿病与并发症的加速进展相关。我们评估了在 30 年的随访中，与较晚发病相比，年轻起病（<40 岁）的患者在发病时年龄较小，其并发症和死亡率是否存在差异。
方法
本研究使用了 UKPDS 收集的数据，这些数据来自于 1977 年至 2007 年间诊断为新发性 2 型糖尿病的患者，这些患者年龄在 25-65 岁之间，起病年龄较轻（<40 岁）或较晚（40 岁或以上），且未患有糖尿病自身抗体。我们使用英国一般人群的数据分析标准化死亡率比（SMR），并根据诊断时的 10 岁年龄间隔分析预定结局的发病率。
结果
在 4550 名检测到所有测量的自身抗体均为阴性的参与者中，有 429 名（9.4%）患有年轻起病的 2 型糖尿病。2704 名（59.4%）为男性，平均 HbA1c 为 76mmol/mol（SD 24.6）。中位随访时间为 17.5 年（IQR 12.7-20.8）。年轻起病的 2 型糖尿病患者的 SMR 更高（3.72[95%CI 2.98-4.64]），而较晚起病的 2 型糖尿病患者的 SMR 较低（1.54[1.47-1.61]）。除微血管疾病外（年轻起病者为 14.5[11.9-17.7]，较晚起病者为 12.1[11.3-13.0]，每 1000 人年），所有其他结局在较晚起病的 2 型糖尿病患者中发病率更高。然而，在任何特定年龄，与较晚发病相比，年轻起病的患者在诊断后 5 年内所有糖尿病相关终点、全因死亡率、微血管疾病和心肌梗死的发生率更高。与较晚发病的 2 型糖尿病相比，年轻起病的患者在发病后的前 20 年内平均 HbA1c 更高。在随机分配至强化与常规血糖控制的参与者中，我们未观察到任何因年轻起病与较晚起病的 2 型糖尿病亚组而产生的交互作用。
结论
与一般人群相比，年轻起病的 2 型糖尿病患者的死亡风险更高。年轻起病的 2 型糖尿病患者发生并发症的风险更高，血糖控制更差，这就需要开发服务来识别和管理这些患者。
资金
英国国家健康与保健研究院生物医学研究中心。
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