Mei Y S, Mao F, Zhang R, You X Q, Li J H
Division of Obesity and Metabolic Disease Control and Prevention, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2025 Jul 10;46(7):1160-1167. doi: 10.3760/cma.j.cn112338-20250127-00065.
To investigate the relationship between glycated hemoglobin (HbA1c) level and the occurrence of diabetes complications in patients with type 2 diabetes mellitus in 11 provinces in China. A total of 4 832 patients with type 2 diabetes mellitus from 60 surveillance sites in 11 provinces where national surveillance for chronic diseases and risk factors was conducted in 2010 were selected as the study participants, and a follow-up survey was conducted in 3 516 persons from 2016 to 2017, finally 3 427 patients were included in the analysis after excluding those data exception and incomplete data. Cox proportional risk regression model was used to evalaute the association between HbA1c level and the risk for diabetes complications (macroangiopathy, microangiopathy and diabetic foot), and subgroup analyses were conducted according to the baseline characteristics of the study participants, such as age, gender and smoking status. A total of 3 427 study participants were included in final analysis of the follow up for an average of 6.2 years, in whom 395 suffered from macroangiopathy, 226 suffered from microangiopathy, and 57 suffered from diabetic foot later during the follow-up period. After adjusting for relevant confounders, using the HbA1c <7.0% as a reference, there was no increased risk for macrovascular lesions in the those with HbA1c levels of 7.0%-, 7.5%-, 8.0%-8.4%, and the risk for macrovascular lesions increased by 38% in those with HbA1c ≥8.5% (=1.38,95%:1.06-1.80); the risk for microangiopathies increased by 131% (=2.31,95%:1.46-3.65), 206%(=3.06,95%:1.91-4.90) and 208% (=3.08,95%:2.20-4.30) in those with HbA1c levels of 7.5%-, 8.0%-, ≥8.5%, respectively; and the risk for diabetic foot increased by 253% (=3.53, 95%: 1.89-6.59) in those with HbA1c level ≥8.5%. Subgroup analyses revealed an effect modifying effect of different diabetes diagnosis situations (previously diagnosed and newly diagnosed) on HbA1c level and the risk for microangiopathy. HbA1c level ≥7.5% would increase the risk for microangiopathy in patients with type 2 diabetes mellitus, the higher the level, the higher the risk, and HbA1c level ≥8.5% would increase the risk for macrovascular lesions and diabetic foot. It is necessary to strengthen the health education in diabetic patients to improve their awareness of blood glucose management and the importance of HbA1c level control to effectively reduce or delay the diabetes complications.
为探讨中国11个省份2型糖尿病患者糖化血红蛋白（HbA1c）水平与糖尿病并发症发生情况之间的关系。选取2010年在11个省份60个监测点进行国家慢性病及危险因素监测的4832例2型糖尿病患者作为研究对象，并于2016年至2017年对其中3516人进行随访，最终排除数据异常和数据不完整者后，纳入3427例患者进行分析。采用Cox比例风险回归模型评估HbA1c水平与糖尿病并发症（大血管病变、微血管病变和糖尿病足）风险之间的关联，并根据研究对象的年龄、性别和吸烟状况等基线特征进行亚组分析。最终纳入3427例研究对象进行平均6.2年的随访分析，随访期间有395例发生大血管病变，226例发生微血管病变，57例发生糖尿病足。校正相关混杂因素后，以HbA1c<7.0%为参照，HbA1c水平为7.0% -、7.5% -、8.0% - 8.4%者发生大血管病变的风险未增加，HbA1c≥8.5%者发生大血管病变的风险增加38%（RR = 1.38，95%CI：1.06 - 1.80）；HbA1c水平为7.5% -、8.0% -、≥8.5%者发生微血管病变的风险分别增加131%（RR = 2.31，95%CI：1.46 - 3.65）、206%（RR = 3.06，95%CI：1.91 - 4.90）和208%（RR = 3.08，95%CI：2.20 - 4.30）；HbA1c水平≥8.5%者发生糖尿病足的风险增加253%（RR = 3.53，95%CI：1.89 - 6.59）。亚组分析显示，不同糖尿病诊断情况（既往诊断和新诊断）对HbA1c水平与微血管病变风险有交互作用。HbA1c水平≥7.5%会增加2型糖尿病患者发生微血管病变的风险，且水平越高风险越高，HbA1c水平≥8.5%会增加大血管病变和糖尿病足的风险。有必要加强对糖尿病患者的健康教育，提高其血糖管理意识及HbA1c水平控制的重要性认识，以有效降低或延缓糖尿病并发症的发生。
