Ohkuma Toshiaki, Harris Katie, Woodward Mark, Hamet Pavel, Harrap Stephen, Mancia Giuseppe, Marre Michel, Poulter Neil, Chalmers John, Zoungas Sophia
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Diabetes Care. 2025 Feb 1;48(2):279-284. doi: 10.2337/dc24-1516.
To compare the vascular effects of pursuing more versus less glucose lowering in patients with younger or older age at diabetes diagnosis, and with shorter or longer diabetes duration.
We studied 11,138 participants from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, classified into subgroups defined by age at diabetes diagnosis (≤50, >50-60, and >60 years) and diabetes duration (≤5, >5-10, and >10 years).
Intensive glucose lowering significantly lowered the risk of the primary composite outcome of major macrovascular and microvascular events (hazard ratio 0.90, 95% CI 0.82-0.98) with no evidence of heterogeneity in the proportional effects across subgroups defined by age at diagnosis or diabetes duration (P for heterogeneity = 0.86 and 0.47, respectively). Similar consistent treatment effects were also observed for all-cause death, cardiovascular death, and the components of major vascular events.
Intensive glucose lowering may be recommended irrespective of age at diagnosis or diabetes duration.
比较糖尿病诊断时年龄较小或较大、糖尿病病程较短或较长的患者强化降糖与适度降糖的血管效应。
我们对糖尿病与血管疾病行动研究：培哚普利吲达帕胺片与格列齐特缓释片对照评估（ADVANCE）试验中的11138名参与者进行了研究，根据糖尿病诊断时的年龄（≤50岁、>50至60岁和>60岁）和糖尿病病程（≤5年、>5至10年和>10年）分为亚组。
强化降糖显著降低了主要大血管和微血管事件的主要复合结局风险（风险比0.90，95%可信区间0.82 - 0.98），在根据诊断时年龄或糖尿病病程定义的亚组中，比例效应无异质性证据（异质性P值分别为0.86和0.47）。在全因死亡、心血管死亡以及主要血管事件的组成部分方面也观察到了类似的一致治疗效果。
无论诊断时年龄或糖尿病病程如何，均可推荐强化降糖。
