目的 探讨空腹血糖(fasting plasma glucose,FPG)长期变异性与2型糖尿病(type 2 diabetes mellitus,T2DM)患者脑卒中发病风险的关联.方法 基于江苏省常熟市社区糖尿病患者队列人群,共6 247人纳入分析.≥3次FPG值计算FPG长期变异性指标,包括FPG标准差(standard deviation,SD)、变异系数(coefficient of variation,CV)、平均真实变异(average real variability,ARV)和独立于均值的变异系数(variability independent of mean,VIM).利用 Cox 比例风险回归模型探索FPG长期变异性与T2DM患者脑卒中发病风险的关联,并根据年龄、性别以及糖尿病用药史进行分层分析.结果 队列人群平均随访7.26年,共观察到脑卒中发病1 080人,发病密度为23.81/1 000人年.以FPG长期变异性指标三分位分组(T1～T3),调整相关因素后,Cox比例风险回归模型分析显示,与T1组相比,FPG-SD、FPG-CV、FPG-ARV和FPG-VIM的T2、T3组发生脑卒中的风险均增加,并呈上升趋势(P趋势＜0.01).FPG-SD、FPG-CV、FPG-ARV和FPG-VIM每增加1个SD,脑卒中发生风险均增加,HR值(95％CI)分别为1.09(1.02～1.16)、1.09(1.03～1.16)、1.08(1.02～1.16)和1.10(1.03～1.16);缺血性脑卒中的发病风险均增加,HR值(95％CI)分别为 1.11(1.03～1.19),1.11(1.04～1.18),1.08(1.00～1.15),1.04(1.04～1.17);FPG-ARV每增加1个SD,出血性脑卒中的发病风险增加,HR值(95％CI)为1.25(1.03～1.53).分层分析显示,在年龄≥ 65岁患者(FPG-CV除外)、女性和单用降糖药的T2DM患者中,FPG-SD、FPG-CV、FPG-ARV和FPG-VIM每增加1个SD,其脑卒中发病风险均增加(均P＜0.05).结论 FPG长期变异性与T2DM患者脑卒中发病风险呈正相关,应降低FPG长期变异性.
A prospective cohort study on the long-term fasting plasma glucose variability and risk of stroke among patients with type 2 diabetes mellitus
Objective To investigate the association between long-term fasting plasma glucose(FPG)variability and stroke in patients with type 2 diabetes mellitus(T2DM).Methods The partici-pants were from a community-based diabetes cohort established in Changshu from 2013 to 2014(n=6 247).Long-term glucose variability was assessed using the standard deviation(SD),coefficient of variation(CV),average real variability(ARV),and variability independent of the mean(VIM)across FPG measurements obtained at the more than three visits.The risk of stroke in patients with T2DM was estimated using Cox proportional risk regression models for SD,CV,ARV,VIM and stratified analysis were conducted according to age,gender and history of diabetes medication.Results After an average 7.26 years of follow-up,there were 1 080 incident cases of stroke,giving a crude incidence rate of 23.81/1 000 person-years.The long-term fasting plasma glucose variability was grouped by tertiles(T1-T3).After adjustment,Cox regression analysis showed that compared with the T1 group,FPG-SD,FPG-CV,FPG-ARV and FPG-VIM in T2 and T3 groups were significantly increased the risks of stroke(Ptrend＜0.01).Per 1 standard deviation(SD)higher of FPG-SD,FPG-CV,FPG-ARV and FPG-VIM,the risk of stroke was significantly increased,the HR(95％CI)were 1.09(1.02-1.16),1.09(1.03-1.16),1.08(1.02-1.16)and 1.10(1.03-1.16)respectively.Per 1 SD higher of FPG-SD,FPG-CV,FPG-ARV and FPG-VIM,the risk of ischemic stroke was significantly increased,the HR(95％CI)were 1.11(1.03-1.19),1.11(1.04-1.18),1.08(1.00-1.15),1.04(1.04-1.17),respectively.Per 1 SD higher of FPG-ARV,the risk of hemorrhagic stroke was significantly increased,the HR(95％CI)was 1.25(1.05-1.48).Stratified analysis showed that in the patients of ≥ 65 years of age(except FPG-CV),women and oral hypoglycemic agents,per 1 SD higher of FPG-SD,FPG-CV,FPG-ARV and FPG-VIM,the risk of ischemic stroke increased significantly(P＜0.05).Conclusions Long-term FPG glycemic variability is positively associated with the risk of stroke in type 2 diabetes patients.
Fasting plasma glucose variabilityType 2 diabetes mellitusStrokeCohort study
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