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2型糖尿病の患者におけるHbAの関数としての生存率:遡及的なコホート研究
Craig J Currie1, John R Peters, Aodán Tynan
1Department of Medicine, School of Medicine, Cardiff University, Cardiff, UK. currie@cardiff.ac.uk
Lancet (London, England)
|January 30, 2010
まとめ
非常に低いおよび非常に高い血糖値 (HbA1c) の両方が,2型糖尿病患者の死亡リスクを高めます. 現在の糖尿病ガイドラインは,最低限のHbA1cターゲットを含むように改訂する必要があるかもしれません.
科学分野:
- 内分泌学 エンドックリノロジー
- 糖尿病に関する研究
- 公衆衛生は公衆衛生である.
背景:
- 2型糖尿病における介入研究は,厳格な血糖コントロールに関する安全性に関する懸念を提起しています.
- 血糖化ヘモグロビン (HbA1c) レベルに関連して生存率を評価することは,患者のアウトカムにとって極めて重要です.
研究 の 目的:
- 2型糖尿病患者のHbA1cレベルと全因死亡率の関連性を評価する.
- 死亡率に対する異なる治療法 (口服薬とインスリン) の影響を調査する.
主な方法:
- 1986年から2008年までの50歳以上の2型糖尿病患者の2つの大きな英国コホート (n=47,970) の分析.
- コックスの生存モデルを利用し,年齢,性別,喫煙,心血管疾患のリスクなどの重要な混乱要因を調整した.
- 濃縮された経口療法を受けた患者と,インスリンベースの治療法を受けた患者の死亡率の比較.
主要な成果:
- HbA1cと全因死亡率の間のU型関連が観察され,最も低い危険比率は約7.5%でした.
- 死亡リスクの有意な増加は,基準グループと比較して,最も低い (HR 1.52) および最も高い (HR 1.79) HbA1cデシールで確認されました.
- インスリンベースの療法は,併用の経口薬よりも高い死亡リスク (HR 1.49) と関連していました.
結論:
- 低値と高値の両方のHbA1cの平均値は,2型糖尿病における死亡率と心臓疾患の増加と関連しています.
- 発見は,糖尿病管理ガイドラインを改訂し,最低限のHbA1c目標を組み込む必要性を示唆しています.
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