Ma Haipeng, Zhang Jitao, Meng Bing, Wang Kai, Li Yuhong, Liang Na
Department of Ophthalmology, Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei Province, PR China.
Department of Laboratory Medicine, The First Hospital of Handan, Handan, Hebei Province, PR China.
PLoS One. 2025 May 23;20(5):e0322886. doi: 10.1371/journal.pone.0322886. eCollection 2025.
To investigate whether optimal glycemic control is associated with all-cause mortality, cardiovascular disease mortality, diabetes-related mortality, cancer-related mortality, and complications among individuals with early-onset and late-onset T2D.
We conducted a retrospective cohort study using data from the U.S. National Health and Nutritional Examination Survey (NHANES)1999-2818. Optimal glycemic control was defined as HbA1c<7%, and poor glycemic control as HbA1c≥9%. Mortality and underlying causes of death were ascertained by linkage to national death records through 31 December 2019. Cox proportional hazards regression models adjusted for age, sex, race, education, body mass index (BMI), hypertension, smoking status, alcohol consumption, and physical activity were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between HbA1c levels and mortality. Logistic regression models with the same covariates were employed to calculate odds ratios (ORs) and 95% CIs for complications, supplemented by sensitivity analyses to evaluate the robustness of the findings.
Among the 5946 participants with diabetes, 18.8% were classified as having early-onset T2D (aged < 40 years), 28.7% as having late-onset T2D (aged ≤ 60 years), and 52.5% had average-onset T2D. For individuals with early-onset T2D, the poorly controlled group (HbA1c≥9%) had HRs of 2.00 (95% CI, 1.30-3.09; P = 0.002) for all-cause mortality and 10.04 (95% CI, 2.57-39.32; P = 0.001) for diabetes-related mortality versus the optimal controlled group (HbA1c<7%). The poorly controlled group had odds of 1.80 (95% CI, 1.10-2.94; P = 0.022) for retinopathy and 2.54 (95% CI, 1.65-3.92; P < 0.001) for chronic kidney disease (CKD) versus the optimal controlled group. For individuals with late-onset T2D, the HRs were 0.87 (HR 0.87; 95% CI, 0.54-1.40; P = 0.561) for all-cause mortality and 1.24 (95% CI, 0.33-4.67; P = 0.751) for diabetes-related mortality compared with the optimal controlled group. The poorly controlled group had odds of 2.12 (95% CI, 1.32-3.41; P = 0.002) for retinopathy and 2.30 (95% CI, 1.45-3.63; P = 0.001) for CKD versus the optimal controlled group.
Optimal glycemic control was associated with a reduced risk of all-cause mortality, diabetes-related mortality, retinopathy, and CKD in individuals with early-onset T2D; however, in individuals with late-onset T2D, this correlation was limited to lower risks of retinopathy and CKD. These findings suggest that glycemic control strategies should be tailored on the basis of the age of diabetes onset.
研究最佳血糖控制与早发型和晚发型2型糖尿病患者的全因死亡率、心血管疾病死亡率、糖尿病相关死亡率、癌症相关死亡率及并发症之间是否存在关联。
我们利用1999 - 2018年美国国家健康与营养检查调查（NHANES）的数据进行了一项回顾性队列研究。最佳血糖控制定义为糖化血红蛋白（HbA1c）<7%，血糖控制不佳定义为HbA1c≥9%。通过与截至2019年12月31日的国家死亡记录进行关联来确定死亡率和潜在死因。使用经年龄、性别、种族、教育程度、体重指数（BMI）、高血压、吸烟状况、饮酒量和身体活动调整的Cox比例风险回归模型来估计HbA1c水平与死亡率之间关联的风险比（HRs）和95%置信区间（CIs）。采用具有相同协变量的逻辑回归模型计算并发症的比值比（ORs）和95% CIs，并辅以敏感性分析以评估研究结果的稳健性。
在5946名糖尿病参与者中，18.8%被归类为早发型2型糖尿病（年龄<40岁），28.7%为晚发型2型糖尿病（年龄≤60岁），52.5%为平均发病年龄的2型糖尿病。对于早发型2型糖尿病患者，血糖控制不佳组（HbA1c≥9%）的全因死亡率HR为2.00（95% CI，1.30 - 3.09；P = 0.002），糖尿病相关死亡率HR为10.04（95% CI，2.57 - 39.32；P = 0.001），而最佳控制组（HbA1c<7%）。血糖控制不佳组视网膜病变的比值比为1.80（95% CI，1.10 - 2.94；P = 0.022），慢性肾病（CKD）的比值比为2.54（95% CI，1.65 - 3.92；P < 0.001），而最佳控制组。对于晚发型2型糖尿病患者，与最佳控制组相比，全因死亡率HR为0.87（HR 0.87；95% CI，0.54 - 1.40；P = 0.561），糖尿病相关死亡率HR为1.24（95% CI，0.33 - 4.67；P = 0.751）。血糖控制不佳组视网膜病变的比值比为2.12（95% CI，1.32 - 3.41；P = 0.002），CKD的比值比为2.30（95% CI，1.45 - 3.63；P = 0.001），而最佳控制组。
最佳血糖控制与早发型2型糖尿病患者的全因死亡率、糖尿病相关死亡率、视网膜病变和CKD风险降低相关；然而，在晚发型2型糖尿病患者中，这种相关性仅限于视网膜病变和CKD风险较低。这些发现表明，血糖控制策略应根据糖尿病发病年龄进行调整。
