背景:肥胖,癌症和糖尿病经常共存。尚未在糖尿病中探讨血糖变异性(GV)和肥胖与癌症事件的关联。
方法:在前瞻性香港糖尿病登记队列(1995-2019)中,我们使用cox比例风险模型来检验GV与全部位癌症(主要结局)和原因特异性死亡(次要结局)的风险关联.我们还探讨了肥胖和GV与这些结果和部位特异性癌症的联合关联。我们使用HbA1c变异性评分(HVS)表达GV,HbA1c变异性评分(HVS)定义为与前次访视值相比HbA1c值变化0.5%的百分比。
结果:我们包括15,286名患者(2型糖尿病:n=15,054,1型糖尿病:n=232),糖尿病≥10年,观察时间≥3年(51.7%的男性,年龄(平均值±SD):61.04±10.73岁,HbA1c:7.54±1.63%,体重指数[BMI]:25.65±3.92kg/m2,全部位癌症事件:n=928,癌症死亡事件:n=404)。HVS和结局之间存在非线性关系,但在高和低HVS组中存在线性,通过HVS的中位数(IQR)值分层(42.31[27.27,56.28])。在高HVS组中,对于全部位癌症(n=874),HVS各SD的校正风险比(aHR)为1.15(95%CI:1.04,1.26).乳房各自的aHR(n=77),肝癌(n=117)和结直肠癌(n=184)分别为1.44(1.07,1.94),1.37(1.08,1.74),和1.09(0.90,1.32)。在高GV组中,各自的aHR为1.21(1.06,1.39),1.27(1.15,1.40),和1.15(1.09,1.22)的癌症,血管,和非癌症非血管性死亡。当按肥胖进行分层时(BMI≥25kg/m2),高HVS和肥胖组的aHR最高,为1.42(1.16,1.73),2.44(1.24,4.82),和2.63(1.45,4.74)分别为所有站点,乳房,和肝癌与低GV和非肥胖组。各自的aHR为1.45(1.07,1.96),1.47(1.12,1.93),癌症为1.35(1.16,1.57),血管,和非癌症非血管性死亡。
结论:肥胖和高GV与所有部位的风险增加有关,乳房,肝癌,和T2D中癌症特异性死亡。
背景:香港中文大学糖尿病研究基金.
BACKGROUND: Obesity, cancer and diabetes frequently coexist. The association of glycaemic variability (GV) and obesity with cancer events had not been explored in diabetes.
METHODS: In the prospective Hong Kong Diabetes Register cohort (1995-2019), we used cox proportional hazards models to examine the risk associations of GV with all-site cancer (primary outcome) and cause-specific death (secondary outcome). We also explored the joint association of obesity and GV with these outcomes and site-specific cancer. We expressed GV using HbA1c variability score (HVS) defined as percentage of HbA1c values varying by 0.5% compared with values in preceding visit.
RESULTS: We included 15,286 patients (type 2 diabetes: n=15,054, type 1 diabetes: n=232) with ≥10 years of diabetes and ≥3 years of observation (51.7% men, age (mean±SD): 61.04±10.73 years, HbA1c: 7.54±1.63%, body mass index [BMI]: 25.65±3.92 kg/m2, all-site cancer events: n=928, cancer death events: n=404). There were non-linear relationships between HVS and outcomes but there was linearity within the high and low HVS groups stratified by the median (IQR) value of HVS (42.31 [27.27, 56.28]). In the high HVS group, the adjusted hazard ratios (aHR) of each SD of HVS was 1.15 (95% CI: 1.04, 1.26) for all-site cancer (n=874). The respective aHRs for breast (n=77), liver (n=117) and colorectal (n=184) cancer were 1.44 (1.07, 1.94), 1.37 (1.08, 1.74), and 1.09 (0.90, 1.32). In the high GV group, the respective aHRs were 1.21 (1.06, 1.39), 1.27 (1.15, 1.40), and 1.15 (1.09, 1.22) for cancer, vascular, and noncancer nonvascular death. When stratified by obesity (BMI ≥25 kg/m2), the high HVS & obese group had the highest aHRs of 1.42 (1.16, 1.73), 2.44 (1.24, 4.82), and 2.63 (1.45, 4.74) respectively for all-site, breast, and liver cancer versus the low GV & non-obese group. The respective aHRs were 1.45 (1.07, 1.96), 1.47 (1.12, 1.93), and 1.35 (1.16, 1.57) for cancer, vascular, and noncancer nonvascular death.
CONCLUSIONS: Obesity and high GV were associated with increased risk of all-site, breast, liver cancer, and cancer-specific death in T2D.
BACKGROUND: The Chinese University of Hong Kong Diabetes Research Fund.