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To investigate the arterial stiffness (AS) risk within urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) categories and the joint effect between kidney disease parameters and metabolic goal achievement on AS risk in adult people with type 2 diabetes (T2D).A total of 27 439 Chinese participants with T2D from 10 National Metabolic Management Centers (MMC) were categorized into four albuminuria/decreased eGFR groups. The criteria for decreased eGFR and AS were eGFR90 ml/min/1.73 mAfter full adjustment, odds ratios (ORs) for AS were highest for albuminuria and decreased eGFR (2.23 [1.98-2.52]) and were higher for albuminuria and normal eGFR (1.52 [1.39-1.67]) than for those with nonalbuminuria and decreased eGFR (1.17 [1.04-1.32]). Both UACR and eGFR in the subgroup or overall population independently correlated with AS risk. The achievement of ≥2 metabolic goals counteracted the association between albuminuria and AS risk (OR: 0.93; 95% CI: 0.80-1.07; p = .311). When the metabolic goals added up to ≥2 for patients with decreased eGFR, they showed significantly lower AS risk (OR: 0.65; 95% CI: 0.56-0.74; p .001).Both higher UACR and lower eGFR are determinants of AS risk, with UACR more strongly related to AS than eGFR in adults with T2D. The correlation between albuminuria/decreased eGFR and AS was modified by the achievement of multiple metabolic elements.背景: 探讨成人2型糖尿病(T2D)患者尿白蛋白/肌酐(UACR)和估计肾小球滤过率(eGFR)两类指标对动脉硬化(AS)风险的影响, 以及肾脏疾病和代谢目标实现程度对AS风险的联合影响。 方法: 将来自10个国家代谢管理中心(MMC)的27439名T2D受试者分为4个白蛋白尿/eGFR降低组。以eGFR90ml/min/1.73m

To investigate the different efficacies of glycemic control between basal and premixed insulin in participants with type 2 diabetes (T2DM) when non-insulin medications fail to reach treatment targets.This was a prospective, large-scale, real-world study at 10 diabetes centers in China. Between June 2017 and June 2021, we enrolled 1104 T2DM participants initiated with either once-daily basal insulin or twice-daily premixed insulin when the glycosylated hemoglobin (HbA1c) control target was not met after at least two non-insulin agents were administered. A Cox proportional hazards regression model adjusting for multiple influencing factors was performed to compare the different effects of basal and premixed insulin on reaching the HbA1c control target.At baseline, basal insulin (57.3%) was prescribed more frequently than premixed insulin (42.7%). Patients with a higher body mass index (BMI) or higher HbA1c levels were more likely to receive premixed insulin than basal insulin (both p 0.001). After a median follow-up of 12.0 months, compared to those with premixed insulin, the hazard ratio for reaching the HbA1c target to those with basal insulin was 1.10 (95% CI, 0.92-1.31; p = 0.29) after adjustment, and less weight gain was observed in those with basal insulin than with premixed insulin (percentage change of BMI from baseline -0.37[5.50]% vs 3.40[6.73]%, p 0.0001).In this real-world study, once-daily basal insulin was more frequently prescribed and had similar glycemic control effects but less weight gain compared with twice-daily premixed insulin when used as initiation therapy for those in whom glycemic control with non-insulin medications failed.背景: 探究当非胰岛素降糖药物不能达到控制目标时, 基础胰岛素和预混胰岛素对2型糖尿病(T2DM)患者血糖控制的疗效差异。 方法: 这是一项在中国10个糖尿病中心进行的前瞻性大规模真实世界研究。在2017年6月至2021年6月期间, 我们共纳入了1104位2型糖尿病患者, 均在使用至少两种非胰岛素降糖药治疗时糖化血红蛋白(HbA1c)未达标后开始启用每天一次基础胰岛素或每天两次预混胰岛素治疗。采用Cox比例风险回归模型矫正多个影响因素, 比较基础胰岛素和预混合胰岛素对HbA1c控制的效果。 结果: 基线数据显示, 基础胰岛素的处方频率(57.3%)高于预混胰岛素(42.7%)。体重指数(BMI)或HbA1c水平较高的患者接受预混胰岛素治疗的可能性高于基础胰岛素(P0.001)。经过中位12个月的随访, 与预混胰岛素组相比, 校正后的基础胰岛素组患者HbA1c达标的风险比(95%CI)为1.10(0.92-1.31, P=0.29), 而体重增加的程度相对较小(BMI增加百分比为-0.37[5.50]% vs. 3.40[6.73]%, P0.0001)。 结论: 在这项真实世界研究中, 在使用非胰岛素降糖药物血糖控制失败后作为起始治疗时, 每日一次的基础胰岛素与每日两次预混胰岛素治疗方案相比, 前者更为常用。两者虽具有相似的血糖控制效果, 但每日一次的基础胰岛素治疗体重增加更少。.

To determine whether the follow-up frequency for type 2 diabetes mellitus (T2DM) patients in the National Metabolic Management Centers (MMCs) leads to different clinical outcomes.A total of 19 908 T2DM patients with at least 6 months of facility-based follow-up were recruited in MMCs between June 2017 and April 2021 and divided into lower-frequency and higher-frequency follow-up (LFF and HFF) groups according to the median follow-up frequency of 2.0 (interquartile range 1.2) times per year. Metabolic parameters at baseline and at the last follow-up visit were analyzed. Multivariable linear regression models were performed to assess the relationship between follow-up frequency and between-group percentage changes, adjusting for the major covariables. Additional stratified analyses were conducted to evaluate the metabolic outcomes in the subgroups.The characteristics of the participants in the LFF and HFF groups were significantly different at baseline. Participants had significant improvements in multiple metabolic parameters after follow-up. Patients with HFF showed significantly greater decrease in percentage changes of fasting blood glucose (-4.95% ± 37.96% vs -2.21% ± 43.08%, P .0001) and glycosylated hemoglobin (HbA1c) (-12.14% ± 19.78% vs -9.67% ± 20.29%, P .0001) after adjustments compared to those with LFF. Furthermore, stratification analyses showed that significant between-group percentage changes of HbA1c were observed in those with younger age (55 years) and higher HbA1c (9%) at baseline (P for interaction.001).HFF is associated with better metabolic outcomes. Participants, especially with younger age or worse HbA1c at baseline in the HFF group achieved better glycemic control than those in the LFF group.背景: 本研究旨在确定国家代谢管理中心(MMC)对2型糖尿病(T2D)患者的随访频率是否会导致不同的临床结果。 方法: 选择2017年6月至2021年4月在MMC进行至少6个月随访的2型糖尿病患者19,908例, 根据每年2.0次(IQR, 1.2)的中位数随访频率, 分为低频组(LFF)和高频组(HFF)。分析基线和末次随访时的代谢参数。采用多变量线性回归模型评估经主要协变量校正后的随访率和组间百分比变化之间的关系。另外还进行了分层分析, 以评估各亚组的代谢结果。 结果: LFF组和HFF组的受试者在基线时的特征有显著差异。随访后, 受试者的多项代谢参数均有显著改善。校正后HFF组的空腹血糖(-4.95±37.96% vs -2.21±43.08%, P0.0001)和糖化血红蛋白(HbA1c) (-12.14±19.78% vs -9.67±20.29%, P0.0001)比LFF组显著下降。此外, 分层分析显示, 在基线时年龄较小(55岁)和HbA1c较高(9%)的人群中, HbA1c的组间百分比变化显著(P0.001)。 结论: HFF与较好的代谢结局有关。HFF组较年轻或基线HbA1c较差的受试者, 其血糖控制效果好于LFF组。.

Atherosclerosis is a common complication in patients with type 2 diabetes (T2DM). Multiple factors are involved in the development and progress of atherosclerosis. We evaluated the association of weekly sedentary time (WST) with carotid plaque formation.After data cleaning, a total of 26 664 participants with T2DM from 10 National Metabolic Management Centers (MMCs) from June 2017 to April 2021 were enrolled. Self-reported lifestyle data including WST, sleeping time, smoking and drinking information, carotid artery ultrasound, and biochemical parameters were obtained. The independent association of carotid plaue with sedentary and other lifestyle behaviors was evaluated using multivariable logistic regression models, and odds ratio (OR) with 95% confidence interval (CI) were reported. Moreover, stratified analysis was conducted to demonstrate the influence of confounding factors.The mean (SD) age of the participants was 54.0 (11.6) years, and the median (interquartile range) WST was 35.0 (21.0, 42.0) h. Comparing with participants in the first tertile of WST, those in the second or third tertile of WST were younger and with a shorter duration of diabetes. There were positive associations between longer sedentary time and odds of artery plaque after adjustment, with corresponding ORs in the second and third tertile were 1.40 (95% CI: 1.31-1.50) and 1.67 (95% CI: 1.56-1.79), respectively. However, the effect of WST on plaque in patients aged 18-40 years old had no statistical significance; the p value in the third tertile was 0.163.In summary, higher WST appears to be associated with higher prevalence of carotid plaque in patients with T2DM, especially in aged populations.背景: 动脉粥样硬化是2型糖尿病患者的常见并发症。动脉粥样硬化的发生发展涉及多种因素。我们评估了每周久坐时间(WST)与颈动脉斑块形成的关系。 方法: 数据清理后, 纳入2017年6月至2021年4月10个国家代谢管理中心(MMC)的26664例2型糖尿病患者。自报生活方式资料包括WST, 睡眠时间, 吸烟和饮酒情况, 颈动脉超声和生化指标。用多变量Logistic回归模型评估久坐与其他生活方式行为之间的独立关联, 并报告95%可信区间(CI)的优势比(OR)。此外, 还对混杂因素进行了分层分析, 论证了混杂因素的影响。 结果: 受试者的平均年龄为54.0(11.6)岁, WST的中位数(四分位数范围)为35.0(21.0, 42.0)小时。与WST前3分位数的受试者相比, WST第二或第三3分位数的受试者年龄更小, 糖尿病病程更短。调整后久坐时间与动脉斑块形成的OR值呈正相关, 调整后2, 3分位数的OR值分别为1.40(95%CI:1.31~1.50)和1.67(95%CI:1.56~1.79)。而WST对18~40岁患者斑块的影响无统计学意义, 第三3分位数P值为0.163。 结论: 高WST似乎与T2 DM患者颈动脉斑块的高患病率有关, 尤其是在老年人群中。.