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青少年发病的2型糖尿病的远期并发症
Long-Term Complications in Youth-Onset Type 2 Diabetes


TODAY Study Group* 糖尿病 妇产科和儿科 • 2021.07.29
相关阅读
• 青少年2型糖尿病患者维持血糖控制的临床试验

摘要


背景

青少年的2型糖尿病患病率在不断增加,但关于这些青少年逐步成年后的相关并发症发生情况,目前知之甚少。

 

方法

我们之前开展了一项多中心临床试验(2004—2011年),在青少年发病的2型糖尿病参与者中评估了三种治疗方案之一(二甲双胍、二甲双胍+罗格列酮或二甲双胍+强化生活方式干预)对至血糖控制不佳的时间产生的影响。完成上述试验后,参与者的治疗方案转变为二甲双胍、胰岛素或二甲双胍+胰岛素,并被纳入一项分两阶段实施的观察性随访研究(2011—2020年);本文发表随访研究的结果。本试验每年对参与者进行一次糖尿病肾病、高血压、血脂异常和神经疾病评估,每年进行两次视网膜疾病评估;并对本研究之外发现的糖尿病相关并发症进行确认和判定。

 

结果

在随访研究第二阶段结束时(2020年1月),被纳入分析的500例参与者的平均(±SD)年龄为26.4±2.8岁,距离确诊糖尿病的平均时间为13.3±1.8年。高血压的累积发病率为67.5%,血脂异常发病率为51.6%,糖尿病肾病发病率为54.8%,神经疾病发病率为32.4%。2010—2011年,视网膜疾病(包括较晚期的阶段)患病率为13.7%,2017—2018年的患病率为51.0%。60.1%的参与者发生了至少一种并发症,28.4%发生了至少两种并发症。发生并发症的危险因素包括少数人种或族群、高血糖、高血压和血脂异常。随访期间未记录到不良事件。

 

结论

在青少年发病的2型糖尿病患者中,并发症(包括微血管并发症)风险随时间推移不断增加,大多数参与者在成年早期已出现并发症。并发症在少数人种和族群中,以及在有高血糖、高血压和血脂异常的患者更为多发(由美国国立糖尿病、消化系统疾病和肾脏疾病研究所[National Institute of Diabetes and Digestive and Kidney Diseases]等资助,在ClinicalTrials.gov注册号为NCT01364350和NCT02310724)。





作者信息

TODAY Study Group*
From the University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora (P.B., P.Z.); George Washington University, Rockville, MD (K.L.D., B.T.); Yale University, New Haven, CT (S.C.); Case Western Reserve University, Rainbow Babies and Children’s Hospital, Cleveland (R.G.-K.); the Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston (D.M.N.); the University of Oklahoma Health Sciences Center, Oklahoma City (J.T.); and Washington University School of Medicine, St. Louis (N.H.W.). Address reprint requests to Dr. Drews at the Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, or at kdrews@bsc.gwu.edu. *The members of the TODAY Study Group are listed in the Supplementary Appendix, available at NEJM.org.

 

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