背景:糖尿病诊断后发生的糖尿病酮症酸中毒(DKA)通常与其他糖尿病相关并发症的危险因素有关。我们旨在确定DKA对1型糖尿病(T1D)全因死亡率和并发症的预后影响。
方法:以前从糖尿病控制和并发症试验/糖尿病干预和并发症流行病学(DCCT/EDIC)研究中收集的数据是通过NIDDK中央存储库获得的。使用具有时间相关协变量的Cox比例风险模型,我们检查了年龄和性别,HbA1c-,以及DKA与全因死亡率的完全校正关联,心血管疾病,微血管,和超过34年的急性并发症。
结果:在1441名参与者中,297有488个DKA事件。先前的DKA与年龄和性别调整后的全因死亡率的风险较高相关(风险比(HR)8.28,95%置信区间(CI)3.74-18.32,p<0.001),主要不良心血管事件(MACE)(HR2.05,95CI1.34-3.13,p<0.001),与之前没有DKA相比,所有晚期微血管和急性并发症。即使在校正协变量后,除视网膜病变外,大多数关联也是显着的。在我们完全调整的分析中,之前的DKA与随后的全因死亡率风险显著升高相关(HR9.13,95CI3.87-21.50;p<0.001),MACE(HR1.66,95CI1.07-2.59;p=0.03),晚期肾脏疾病(HR2.10,95CI1.00-4.22;p=0.049),晚期神经病变(HR1.49,95CI1.05至2.13;p=0.03),重度低血糖(HR1.53,95CI1.28-1.81;p<0.001)和复发性DKA(HR3.24,95CI2.41-4.36,p<0.001)。
结论:DKA是糖尿病并发症的预后指标,包括过多全因死亡率。DKA诊断后,可能需要加强临床干预措施,例如心血管预防策略。
OBJECTIVE: Diabetic ketoacidosis (DKA) occurring after diabetes diagnosis is often associated with risk factors for other diabetes-related complications. In this study we aimed to determine the prognostic implications of DKA on all-cause mortality and complications in type 1 diabetes (T1D).
METHODS: Previously collected data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study were obtained through the the National Institute of Diabetes and Digestive and Kidney Diseases Central Repository. Using Cox proportional hazards models with time-dependent covariates, we examined age- and sex-adjusted, glycated hemoglobin-adjusted, and fully adjusted associations of DKA with all-cause mortality, cardiovascular disease, microvascular, and acute complications over 34 years.
RESULTS: Of the 1,441 study participants, 297 had 488 DKA events. Prior DKA was associated with a higher risk of age- and sex-adjusted all-cause mortality (hazard ratio [HR] 8.28, 95% confidence interval [CI] 3.74 to 18.32, p<0.001), major adverse cardiovascular events (MACEs) (HR 2.05, 95% CI 1.34 to 3.13, p<0.001), and all advanced microvascular and acute complications compared with no prior DKA. Most associations except retinopathy were significant even after adjustment for covariates. In our fully adjusted analysis, prior DKA was associated with a significantly higher risk of subsequent all-cause mortality (HR 9.13, 95% CI 3.87 to 21.50, p<0.001), MACEs (HR 1.66, 95% CI 1.07 to 2.59, p=0.03), advanced kidney disease (HR 2.10, 95% CI 1.00 to 4.22, p=0.049), advanced neuropathy (HR 1.49, 95% CI 1.05 to 2.13, p=0.03), severe hypoglycemia (HR 1.53, 95% CI 1.28 to 1.81, p<0.001), and recurrent DKA (HR 3.24, 95% CI 2.41 to 4.36, p<0.001) compared with person-time without DKA.
CONCLUSIONS: DKA is a prognostic marker for diabetes complications, including excess all-cause mortality. Intensified clinical interventions, such as cardiovascular prevention strategies, may be warranted after diagnosis of DKA.