diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13195diaendo-13195Research ArticleОригинальные исследованияOriginal StudiesРиски смертельных исходов при различных клинических фенотипах у больных сахарным диабетом 2 типа в Новосибирской областиRisks of mortality for various phenotypes in patients with type 2 diabetes mellitus in the Novosibirsk regionhttps://orcid.org/0000-0003-4641-3874БондарьИ. А.BondarI. A.

Бондарь Ирина Аркадьевна - д.м.н., профессор.

Новосибирск

Бондарь Ирина Аркадьевна - д.м.н., профессор.

Новосибирск

bondaria@oblmed.nsk.ruhttps://orcid.org/0000-0003-3906-4784ШабельниковаО. Ю.ShabelnikovaO. Y.

Шабельникова Олеся Юрьевна - к.м.н.

630087, Новосибирск, ул. Немировича-Данченко, д. 130

Olesia Y. Shabelnikova - MD, PhD.

130 Nemirovicha-Danchenko street, 630091 Novosibirsk

oyushabelnikova@yandex.ruНовосибирский государственный медицинский университетРоссияNovosibirsk State Medical UniversityRussian FederationНовосибирская областная клиническая больница, НовосибирскРоссияNovosibirsk Regional Clinical HospitalRussian Federation202418012025276580588Copyright © Бондарь И.А., Шабельникова О.Ю., 20252025Бондарь И.А., Шабельникова О.Ю.Bondar I.A., Shabelnikova O.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13195ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Сахарный диабет 2 типа (СД2) — заболевание с высокой распространенностью и ранней смертностью, а выделение групп риска неблагоприятных исходов имеет важное значение во вторичной профилактике.

ЦЕЛЬ

ЦЕЛЬ. Изучить клинические, метаболические и генетические факторы риска отдаленных смертельных исходов при различных клинических фенотипах у больных СД2 в Новосибирской области.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Проведено проспективное когортное исследование в Новосибирской области 2507 больных СД2. Длительность наблюдения составила 6,3±2,5 года. В зависимости от уровня С-пептида и индекса НОМА-IR пациенты были распределены на 3 фенотипа: инсулинопенический (n=288), классический (n=1921), инсулинорезистентный (n=298). Летальный исход за период с 2014 по 31.12.2022 зарегистрирован у 592 пациентов (23,6%). Выделение ДНК, генотипирование структурных вариантов генов TCF7L2 (rs7903146), ATM (rs11212617) проводили с помощью ПЦР.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Ведущей причиной смерти больных СД2, независимо от клинического фенотипа были сердечно-сосудитсые заболевания (ССЗ) (63,8%). Пациенты с инсулинорезистентным фенотипом имели значимо меньшую длительность диабета на момент смерти 12,3±5,5 года по сравнению с классическим и инсулинопеническим фенотипом (р<0,001). Факторами риска общей смертности, по данным многофакторного регрессионного анализа Кокса (ОР), были длительность СД2 (1,043, р<0,001), уровень HbA1c (1,131, р<0,001), креатинина (1,013, р=0,002), наличие аллеля Т гена TCF7L2 (rs7903146) (ОР=1,431, р=0,017) и аллеля С гена ATM (rs11212517) (ОР=1,509, р=0,007). Предикторами сердечно-сосудистой смерти были HbA1c (ОР=1,129, р=0,001), длительность диабета (ОР=1,041, р=0,002), уровень креатинина (ОР=1,015, р=0,004), наличие аллеля Т гена TCF7L2 (rs7903146) (ОР=1,719, р=0,005) и аллеля С гена ATM (ОР=1,539, р=0,024).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Исследование выявило, что пациенты с инсулинорезистеным фенотипом имели неблагоприятный прогноз. Основным предиктором общей и сердечно-сосудистой смерти являлся HbA1c. Наличие аллеля Т гена TCF7L2 (rs7903146) увеличивало риск общей смертности на 43,1%, аллеля С гена ATM (rs11212617) на 50,9%.

BACKGROUND

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a disease with high prevalence and early mortality, and identifying groups at risk for adverse outcomes is important in secondary prevention.

AIM

AIM: To study clinical, metabolic and genetic risk factors for deaths in various clinical phenotypes in patients with type 2 diabetes mellitus in the Novosibirsk region.

MATERIALS AND METHODS

MATERIALS AND METHODS: A prospective cohort study was conducted of 2507 patients with T2DM. The follow-up duration was 6.3±2.5 years. Depending on the level of C-peptide and the HOMA-IR index, patients were divided into 3 phenotypes: insulinopenic (n=288), classic (n=1921), insulin-resistant (n=298). Fatal outcome for the period from 2014 to 31.12.2022 was recorded in 592 patients (23.6%). DNA isolation and genotyping of structural variants of the TCF7L2(rs7903146), ATM(rs11212617) genes were performed by PCR.

RESULTS

RESULTS: The main cause of death in patients with T2DM in all phenotypes was CVD (63.8%). Patients with an insulin-resistant phenotype had a significantly shorter duration of diabetes at the time of death, 12.3±5.5 years, compared with the classic and insulinopenic phenotype (p<0.001). Risk factors for mortality from all causes according to multivariate Cox regression analysis (OR) were the duration of T2DM (1.043, p<0.001), the level of HbA1c (1.131, p<0.001), creatinine (1.013, p=0.002), the T allele of the TCF7L2(rs7903146) gene (OR=1.431, p=0.017) and allele C of the ATM(rs11212517) gene (OR=1.509, p=0.007). Predictors of cardiovascular death were HbA1c (OR=1.129, p=0.001), duration of diabetes (OR=1.041, p=0.002), creatinine level (OR=1.015, p=0.004), the T allele of the TCF7L2(rs7903146) gene (OR=1.719, p=0.005) and allele C of the ATM gene (OR=1.539, p=0.024).

CONCLUSION

CONCLUSION: The study found that patients with an insulin-resistant had a poor prognosis. The main predictor of general and cardiovascular death was HbA1c. The T allele of the TCF7L2(rs7903146) gene increased the risk of overall mortality by 43.1%, the C allele of the ATM(rs11212617) gene by 50.9%.

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The authors declare that there are no conflicts of interest present.