Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期

　　为了比较2型糖尿病(T2DM)长期存活者和死亡者的临床特征。来自印度马德拉斯糖尿病研究基金会的Mohan博士等人进行了一项研究，研究发现，T2DM长期存活者有较好的血糖和血压控制以及脂类代谢。研究结果在线发表于2013年4月5日的美国《糖尿病护理》(Diabetes Care)杂志上。

　　研究人员对200,000多名患者的医疗记录进行回顾性调查后，确定T2DM存活者(糖尿病病程>40年)和与其发病年龄及性别匹配的T2DM死亡者。对并发症发病率和死亡原因进行分析。采用视网膜摄影术诊断视网膜病。对两组患者微量白蛋白尿和大量白蛋白尿、外周血管疾病(踝臂指数<0.9)、冠状动脉疾病(有心肌梗塞或冠状动脉重建术病史)、神经病变(振动知觉阈值>20V)进行比较。

　　结果显示，糖尿病存活者(n=238)平均病程43.7±3.9年，死亡患者(n=307)死亡时病程22.4±11.0年(P<0.001)。与长期存活者比较，死亡患者收缩压和舒张压、血糖、HbA1c、血清胆固醇、LDL胆固醇和甘油三酯显著升高，HDL胆固醇显著降低(除收缩压P=0.027外，其它指标P<0.001)。最常见的死亡原因为心肌梗塞(46.4%)和肾衰竭(16.6)。由于病程长和年龄较大，存活者的并发症发病率比死亡患者高，二者比较如下：视网膜病：76%vs.62%；微量白蛋白尿：39.1%vs.27.3%；大量白蛋白尿，8.4%vs.23.7%；神经病变：86.5%vs.63.5%；外周血管疾病：23.1%vs.11.4%；冠状动脉疾病：44.5%vs.40.7%。

　　研究表明，T2DM长期存活患者有较好的血糖和血压控制，以及更有利的脂类代谢。

与糖尿病相关的拓展阅读：

• 第一时相胰岛素分泌减少是我国2型糖尿病关键诱因
• 高血压患者治疗时HDL低预示新发糖尿病风险更高
• AACE2013糖尿病治疗方案
• 美国糖尿病防治十年进展回顾
• NEJM：糖尿病治疗有进展但仍存不足 更多信息请点击：有关糖尿病更多资讯

Clinical Profile of Long-Term Survivors and Nonsurvivors With Type 2 Diabetes.
OBJECTIVE
To compare clinical profile of long-term survivors and nonsurvivors with type 2 diabetes (T2DM).
RESEARCH DESIGN AND METHODS
After conducting a retrospective survey of >200,000 case records, we identified T2DM survivors (>40 years of duration) and age at diagnosis and sex-matched T2DM nonsurvivors. Prevalence of complications and causes of death were analyzed. Retinopathy was diagnosed by retinal photography. Microalbuminuria and macroalbuminuria, peripheral vascular disease based on ankle-brachial index <0.9, coronary artery disease, based on history of myocardial infarction or coronary revascularization, and neuropathy, based on vibration perception threshold >20 V, were compared in both groups.
RESULTS
The mean duration of diabetes of survivors (n = 238) was 43.7 ± 3.9 years and that of the nonsurvivors (n = 307), at time of death, was 22.4 ± 11.0 years (P < 0.001). Nonsurvivors had significantly higher systolic and diastolic blood pressures, plasma glucose, HbA1c, serum cholesterol, LDL cholesterol, triglycerides, and lower HDL cholesterol compared with long-term survivors (P < 0.001 for all parameters except systolic blood pressure, which was P = 0.027). Myocardial infarction (46.4%) and renal failure (16.6%) were the most common causes of death. Prevalence of most complications were higher among survivors because of longer duration and older age, as follows, for survivors versus nonsurvivors: retinopathy, 76 vs. 62%; microalbuminuria, 39.1 vs. 27.3%; macroalbuminuria, 8.4 vs. 23.7%; neuropathy, 86.5 vs. 63.5%; peripheral vascular disease, 23.1 vs. 11.4%; and coronary artery disease, 44.5 vs. 40.7%.
CONCLUSIONS
Long-term survivors with T2DM had better glycemic and blood pressure control and more favorable lipid profiles.