2 型糖尿病患者的社会隔离、孤独感与微血管并发症风险。

IF 9.4 1区 医学 Q1 UROLOGY & NEPHROLOGY American Journal of Kidney Diseases Pub Date : 2024-06-24 DOI:10.1053/j.ajkd.2024.05.004
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引用次数: 0

摘要

理由和目标社会隔离与不良的心脏代谢健康有关。本研究旨在调查社会隔离和孤独感与 2 型糖尿病(T2DM)患者糖尿病微血管并发症(DMC)的关系,并将这些关系与传统风险因素的关系进行比较:前瞻性队列研究:暴露:社会隔离和孤独感通过自我报告问卷进行测量:结果:DMC的发生率,定义为糖尿病肾病、糖尿病视网膜病变或糖尿病神经病变的综合:分析方法:多变量特定病因危险回归。为了比较社会脱节与其他既定因素的相对重要性,计算了 Cox 模型的 R2 值:在中位 12.6 年的随访期间,共有 5530 名患者被记录为 DMC 患者(3458 名糖尿病肾病患者、2255 名糖尿病视网膜病变患者和 1146 名糖尿病神经病变患者)。社会隔离程度越高,罹患任何一种 DMC 的风险越高(最高与最低:HR:1.13;95% CI:1.05-1.22),尤其是糖尿病肾病(HR:1.14,95% CI:1.04-1.25)和神经病变(HR:1.31,95% CI:1.11-1.53)。任何程度的孤独感都与任何 DMC 成分(HR:1.12;95% CI:1.02-1.23)和糖尿病肾病(HR:1.16,95% CI:1.03-1.30)的风险增加有关。社会隔离和孤独与 DMC 的关系与其他常规风险因素(包括吸烟、血压和体力活动)相当:局限性:与英国生物库研究参与者的构成有关,可推广性有限:社会隔离和孤独与 T2DM 患者发生 DMC 的较高风险独立相关,其重要性与其他传统风险因素相当。这些研究结果表明,社会隔离和孤独是DMC的新的潜在可调节风险因素。
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Social Isolation, Loneliness, and Risk of Microvascular Complications Among Individuals With Type 2 Diabetes Mellitus

Rationale & Objective

Social disconnection has been associated with poor cardiometabolic health. This study sought to investigate the associations of social isolation and loneliness with diabetic microvascular complications (DMCs) among individuals with type 2 diabetes mellitus (T2DM) and compare these associations versus those related to traditional risk factors.

Study Design

Prospective cohort study.

Setting & Participants

A total of 24,297 UK Biobank participants with T2DM and no DMCs at baseline.

Exposure

Social isolation and loneliness were measured using self-reported questionnaires.

Outcome

The incidence of DMCs defined as a composite of diabetic kidney disease, diabetic retinopathy, or diabetic neuropathy.

Analytical Approach

Multivariable cause-specific hazards regression. To compare the relative importance of social disconnection with other established factors, the R2 values of the Cox models were calculated.

Results

During a median follow-up of 12.6 years, 5,530 patients were documented to experience DMCs (3,458 with diabetic kidney disease, 2,255 with diabetic retinopathy, and 1,146 with diabetic neuropathy). The highest level of social isolation was associated with an increased risk of any DMC component (most vs least: HR, 1.13; 95% CI, 1.05-1.22), especially diabetic kidney disease (HR, 1.14; 95% CI, 1.04-1.25) and neuropathy (HR, 1.31; 95% CI, 1.11-1.53). Any level of loneliness was associated with an increased risk of any DMC component (HR, 1.12; 95% CI, 1.02-1.23) and diabetic kidney disease (HR, 1.16; 95% CI, 1.03-1.30). Social isolation and loneliness exhibited associations with DMCs comparable to those of other conventional risk factors, including smoking, blood pressure, and physical activity.

Limitations

Limited generalizability related to the composition of participants in the UK Biobank Study.

Conclusions

Social isolation and loneliness were independently associated with a higher risk of incident DMCs among individuals with T2DM, with comparable importance to other traditional risk factors. These findings underscore social isolation and loneliness as novel and potentially modifiable risk factors for DMCs.

Plain-Language Summary

Social isolation and loneliness are important social determinants that are associated with adverse cardiometabolic health. Individuals with diabetes are particularly vulnerable to social isolation and loneliness. However, the relationship of social isolation or loneliness with diabetic microvascular complications (DMCs) remains unclear. Our study used the UK Biobank study data to investigate the associations of social isolation and loneliness with the development of DMCs. We found that social isolation and loneliness were independently associated with a higher risk of incident DMCs. Remarkably, their association with DMCs was comparable to those of other lifestyle factors such as smoking, blood pressure, and physical activity. These findings collectively imply that social isolation and loneliness are 2 important potentially modifiable risk factors for DMCs among individuals with type 2 diabetes mellitus.
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来源期刊
American Journal of Kidney Diseases
American Journal of Kidney Diseases 医学-泌尿学与肾脏学
CiteScore
20.40
自引率
2.30%
发文量
732
审稿时长
3-8 weeks
期刊介绍: The American Journal of Kidney Diseases (AJKD), the National Kidney Foundation's official journal, is globally recognized for its leadership in clinical nephrology content. Monthly, AJKD publishes original investigations on kidney diseases, hypertension, dialysis therapies, and kidney transplantation. Rigorous peer-review, statistical scrutiny, and a structured format characterize the publication process. Each issue includes case reports unveiling new diseases and potential therapeutic strategies.
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