美国乔治·华盛顿大学Kimberly L. Drews团队研究了青年型2型糖尿病的长期并发症。2021年7月28日，《新英格兰医学杂志》发表了这一成果。

2型糖尿病在青年人中的患病率正在增加，但随着这些青年人向成年人过渡，相关并发症的发生率尚不明确。

研究组之前进行了一项多中心临床试验（2004-2011年）来评估三种治疗方法对青年2型糖尿病患者血糖失控时间的影响，这三种治疗方法分别为二甲双胍、二甲双胍+罗格列酮或二甲双胍+强化生活方式干预。

试验完成后，参与者被转为使用二甲双胍（含或不含胰岛素），并被纳入观察性随访研究（2011-2020年），该研究分两个阶段进行；本后续研究的结果在此报告。每年对糖尿病肾病、高血压、血脂异常和神经疾病进行评估，对视网膜疾病进行两次评估。并确认在研究之外发现的与糖尿病相关并发症。

在后续研究第二阶段（2020年1月）结束时，纳入分析的500名参与者的平均年龄为26.4岁，自诊断为糖尿病以来的平均时间为13.3年。高血压累积发生率为67.5%，血脂异常发生率为51.6%，糖尿病肾病发生率为54.8%，神经疾病发生率为32.4%。

2010-2011年，视网膜疾病（包括更晚期）的患病率为13.7%，2017-2018年间为51.0%。60.1%的受试者发生至少一种并发症，28.4%的受试者发生至少两种并发症。并发症发生的危险因素包括少数族裔、高血糖、高血压和血脂异常。随访期间未记录任何不良事件。

研究结果表明，在年轻时患上2型糖尿病的参与者，并发症（包括微血管并发症）的风险随着时间的推移稳步增加，并在年轻时已影响到大多数参与者。并发症在少数族裔以及高血糖、高血压和血脂异常患者中更为常见。

附：英文原文

Title: Long-Term Complications in Youth-Onset Type 2 Diabetes

Author: TODAY Study Group

Issue&Volume: 2021-07-28

Abstract:

Background

The prevalence of type 2 diabetes in youth is increasing, but little is known regarding the occurrence of related complications as these youths transition to adulthood.

Methods

We previously conducted a multicenter clinical trial (from 2004 to 2011) to evaluate the effects of one of three treatments (metformin, metformin plus rosiglitazone, or metformin plus an intensive lifestyle intervention) on the time to loss of glycemic control in participants who had onset of type 2 diabetes in youth. After completion of the trial, participants were transitioned to metformin with or without insulin and were enrolled in an observational follow-up study (performed from 2011 to 2020), which was conducted in two phases; the results of this follow-up study are reported here. Assessments for diabetic kidney disease, hypertension, dyslipidemia, and nerve disease were performed annually, and assessments for retinal disease were performed twice. Complications related to diabetes identified outside the study were confirmed and adjudicated.

Results

At the end of the second phase of the follow-up study (January 2020), the mean (±SD) age of the 500 participants who were included in the analyses was 26.4±2.8 years, and the mean time since the diagnosis of diabetes was 13.3±1.8 years. The cumulative incidence of hypertension was 67.5%, the incidence of dyslipidemia was 51.6%, the incidence of diabetic kidney disease was 54.8%, and the incidence of nerve disease was 32.4%. The prevalence of retinal disease, including more advanced stages, was 13.7% in the period from 2010 to 2011 and 51.0% in the period from 2017 to 2018. At least one complication occurred in 60.1% of the participants, and at least two complications occurred in 28.4%. Risk factors for the development of complications included minority race or ethnic group, hyperglycemia, hypertension, and dyslipidemia. No adverse events were recorded during follow-up.

Conclusions

Among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by the time of young adulthood. Complications were more common among participants of minority race and ethnic group and among those with hyperglycemia, hypertension, and dyslipidemia.

DOI: 10.1056/NEJMoa2100165

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2100165