Choi Hong Sang, Kim Bongseong, Han Kyung-Do, Suh Sang Heon, Kim Chang Seong, Bae Eun Hui, Ma Seong Kwon, Kim Soo Wan
Department of Internal Medicine, Chonnam National University Medical School and Hospital, Gwangju 61469, South Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea.
World J Diabetes. 2025 Jul 15;16(7):107647. doi: 10.4239/wjd.v16.i7.107647.
Decreased renal function is a well-known risk factor for cardiovascular diseases (CVD) and death. However, the impact of diabetes duration and the glomerular filtration rate (GFR) on cardiovascular complications in patients with type 2 diabetes has not been well studied.
To investigate the complex impact of longer diabetes duration and GFR on CVD and mortality.
Subjects with diabetes age ≥ 20 years, who underwent health check-ups from 2015 to 2016 were identified in the Korean National Health Insurance Service database. Based on diabetes duration, subjects were grouped into new-onset, < 5 years, 5-9 years, or ≥ 10 years. The new-onset diabetes group [estimated GFR (eGFR): ≥ 90 mL/min/1.73 m] was the reference group. A Cox proportional hazards model adjusted for potential confounders was used to estimate the risk for myocardial infarction (MI), ischemic stroke (IS), and mortality.
During a 3.9-year follow-up of 2105228 patients, 36003 (1.7%) MIs, 46496 (2.2%) ISs, and 73549 (3.5%) deaths were documented. Both longer diabetes duration and lower eGFR were independently associated with higher risks of MI, IS, and mortality, which were further amplified when these factors coexisted. Even patients with new-onset diabetes had elevated MI and IS risk at mildly reduced eGFR (60-90 mL/min/1.73 m²). Mortality risk rose appreciably once eGFR declined below 60 mL/min/1.73 m², particularly in those with longer diabetes duration. eGFR ≥ 90 mL/min/1.73 m subgroups had higher death risk than eGFR 60-90 mL/min/1.73 m subgroups regardless of diabetic duration.
Increasing diabetes duration and decreasing eGFR are associated with increased risk of MI, IS, and mortality. For cardiovascular risk estimation, diabetes duration should be considered an important risk factor.
肾功能下降是心血管疾病（CVD）和死亡的一个众所周知的危险因素。然而，糖尿病病程和肾小球滤过率（GFR）对2型糖尿病患者心血管并发症的影响尚未得到充分研究。
探讨较长的糖尿病病程和GFR对CVD及死亡率的综合影响。
在韩国国民健康保险服务数据库中确定了2015年至2016年接受健康检查的年龄≥20岁的糖尿病患者。根据糖尿病病程，将受试者分为新发、<5年、5-9年或≥10年组。新发糖尿病组[估计肾小球滤过率（eGFR）：≥90 mL/min/1.73 m²]为参照组。采用调整了潜在混杂因素的Cox比例风险模型来估计心肌梗死（MI）、缺血性中风（IS）和死亡率的风险。
在对2105228例患者进行3.9年的随访期间，记录到36003例（1.7%）MI、46496例（2.2%）IS和73549例（3.5%）死亡。较长的糖尿病病程和较低的eGFR均与MI、IS和死亡风险较高独立相关，当这些因素共存时，风险会进一步放大。即使是新发糖尿病患者，在eGFR轻度降低（60-90 mL/min/1.73 m²）时，MI和IS风险也会升高。一旦eGFR降至60 mL/min/1.73 m²以下，死亡风险会显著上升，尤其是糖尿病病程较长的患者。无论糖尿病病程如何，eGFR≥90 mL/min/1.73 m²亚组的死亡风险均高于eGFR 60-90 mL/min/1.73 m²亚组。
糖尿病病程延长和eGFR降低与MI、IS和死亡风险增加有关。在进行心血管风险评估时，应将糖尿病病程视为一个重要的危险因素。
