观察到一种称为遗留效应的现象,即新诊断的2型糖尿病(T2D)患者早期血糖控制不良会增加随后发生心血管疾病(CVD)的风险。早期使用一些新型的抗高血糖药物,如钠-葡萄糖转运蛋白2抑制剂(SGLT-2i),可能会减弱这种影响,但证据有限.
■使用鄞州地区卫生保健数据库(YRHCD)收集了2010-2023年新诊断的T2D患者的两个回顾性队列,对早期暴露期进行了不同的定义-1年暴露队列和2年暴露队列,其中包括在T2D诊断后1年内和2年内有HbA1c测量数据的受试者,分别。使用Cox比例风险模型,我们研究了暴露早期高HbA1c水平(HbA1c>7%)与随后的CVD风险之间的关系.这项分析是在整个队列和三个亚群不同的治疗在早期暴露期,包括启动SGLT-2i或胰高血糖素样肽-1受体激动剂(GLP-1RA)的患者,使用二肽基肽酶-4抑制剂(DPP-4i)的患者,和没有使用SGLT-2i的患者,GLP-1RA,和DPP-4i。此外,通过将患者分为年龄<55岁和≥55岁进行亚组分析.
■共有21,477和22,493例新诊断的T2D患者被纳入两个最终队列。与暴露早期平均HbA1c≤7%的患者相比,HbA1c>7%的患者发生CVD的风险更高,在1年和2年暴露期队列中,HR分别为1.165(95CI,1.056-1.285)和1.143(95CI,1.044-1.252)。与非用户相比,在T2D诊断后1或2年内开始SGLT-2i/GLP-1RA的患者,在两个队列中,基线时更高的HbA1c水平与CVD无关.在亚组分析中,结果与主要分析基本一致。
■T2D早期血糖控制不良会增加新诊断T2D的中国成年人的后期CVD风险。与非用户相比,在T2D早期接受SGLT-2i/GLP-1RA的患者中,这种关联较小且无意义,提示早期使用这些药物可能有可能减轻高血糖的遗留影响.
UNASSIGNED: A phenomenon known as legacy effect was observed that poor glycemic control at early stage of patients with newly-diagnosed type 2 diabetes (T2D) increases the risk of subsequent cardiovascular diseases (CVD). Early use of some novel anti-hyperglycemic agents, such as sodium-glucose transport protein 2 inhibitors (SGLT-2i), may attenuate this effect, but the evidence is limited.
UNASSIGNED: Two retrospective cohorts of newly diagnosed T2D patients from 2010-2023 were assembled using the Yinzhou Regional Health Care Database (YRHCD) with different definitions of the early exposure period - the 1-year exposure cohort and 2-year exposure cohort, which were comprised of subjects who had HbA1c measurement data within 1 year and 2 years after their T2D diagnosis, respectively. Using Cox proportional hazards models, we examined the association between high HbA1c level (HbA1c>7%) during the early exposure period and the risk of subsequent CVD. This analysis was performed in the overall cohort and three subpopulations with different treatments during the early exposure period, including patients initiating SGLT-2i or glucagon-like peptide-1 receptor agonists (GLP-1RA), patients using dipeptidyl peptidase-4 inhibitors (DPP-4i), and patients without using SGLT-2i, GLP-1RA, and DPP-4i. Besides, subgroup analyses were performed by stratifying patients into age <55 and ≥55 years.
UNASSIGNED: A total of 21,477 and 22,493 patients with newly diagnosed T2D were included in the two final cohorts. Compared with patients with mean HbA1c ≤ 7% during the early exposure period, those with HbA1c>7% had higher risks of incident CVD, with a HR of 1.165 (95%CI, 1.056-1.285) and 1.143 (95%CI, 1.044-1.252) in 1-year and 2-year exposure period cohort. Compared to non-users, in patients initiating SGLT-2i/GLP-1RA within 1 or 2 years after T2D diagnosis, higher HbA1c level at baseline was not associated with CVD in both two cohorts. In subgroup analyses, results were generally consistent with the main analysis.
UNASSIGNED: Poor glycemic control in the early stage of T2D increased later CVD risk in Chinese adults with newly diagnosed T2D. Compared to non-users, this association was smaller and non-significant in patients receiving SGLT-2i/GLP-1RA during the early stage of T2D, indicating early use of these drugs may have the potential to mitigate legacy effects of hyperglycemia.