Wu Hongjiang, Zhou Haobin, Huang Chuiguo, Yang Aimin, Lau Eric S H, Zhang Xinge, Lui Juliana N M, Fan Baoqi, Shi Mai, Ma Ronald C W, Kong Alice P S, Chow Elaine, So Wing-Yee, Chan Juliana C N, Luk Andrea O Y
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
The First School of Clinical Medicine, Guangzhou Medical University, People's Republic of China.
Lancet Reg Health West Pac. 2025 Mar 31;57:101532. doi: 10.1016/j.lanwpc.2025.101532. eCollection 2025 Apr.
People with type 2 diabetes are increasingly susceptible to complications that are not specific to diabetes. We aimed to examine the temporal trajectories of hospitalisations for traditional and non-traditional complications in people with type 2 diabetes.
We included 758,254 people with incident type 2 diabetes between 2002 and 2018 in Hong Kong, followed up until 2019. We included hospitalisations for 72 selected diseases and all-cause deaths. We derived the temporal trajectories of hospitalisations based on pairs of disease associations and identified trajectory clusters using Markov Cluster Algorithm.
During a median follow-up of 7.8 (IQR: 4-12) years, 57.6% of people experienced a hospitalisation for any of the 72 selected diseases and 22.6% of people died. Among the 5184 directional disease pairs, 95 were identified as having a significant and directional association. The three most common disease pairs were hospitalisations for urinary tract infection followed by pneumonia, ischemic heart disease followed by heart failure, and ischemic stroke followed by pneumonia. Cardiovascular and kidney diseases were predominant in the hospitalisation trajectories. However, these traditional complications had complex associations both among themselves and with various non-traditional complications across multiple systems. Three distinct trajectory clusters were identified, with heart failure/chronic kidney disease, pneumonia, and urinary tract infection as central diseases.
Cardiovascular and kidney diseases interacted with a broad set of non-traditional complications to influence the overall patterns of hospitalisation progression in people with diabetes, highlighting the need to broaden diabetes care to consider complications beyond the traditional focus.
Direct Grant for Research from The Chinese University of Hong Kong.
2型糖尿病患者越来越容易出现并非糖尿病特有的并发症。我们旨在研究2型糖尿病患者因传统和非传统并发症住院的时间轨迹。
我们纳入了2002年至2018年期间香港758254例新发2型糖尿病患者，随访至2019年。我们纳入了72种选定疾病的住院治疗和全因死亡情况。我们根据疾病关联对得出住院时间轨迹，并使用马尔可夫聚类算法识别轨迹聚类。
在中位随访7.8（四分位间距：4 - 12）年期间，57.6%的人因72种选定疾病中的任何一种住院，22.6%的人死亡。在5184对定向疾病对中，95对被确定为具有显著的定向关联。最常见的三对疾病是尿路感染住院后并发肺炎、缺血性心脏病住院后并发心力衰竭、缺血性中风住院后并发肺炎。心血管疾病和肾脏疾病在住院轨迹中占主导地位。然而，这些传统并发症之间以及与多个系统的各种非传统并发症之间都存在复杂的关联。识别出三个不同的轨迹聚类，以心力衰竭/慢性肾脏病、肺炎和尿路感染为核心疾病。
心血管疾病和肾脏疾病与一系列广泛的非传统并发症相互作用，影响糖尿病患者住院进展的总体模式，这凸显了拓宽糖尿病护理范围以考虑传统重点之外并发症的必要性。
香港中文大学直接研究资助。
