Zuag qhia tag nrho thiab ua rau-Specific Mortality nyob rau hauv cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus: Ib tug pej xeem-raws li txoj kev kawm nyob rau hauv Taiwan los ntawm 1998 mus txog 2014
Apr 19, 2024
Taw qhia
Hom 1 mob ntshav qab zib mellitus yog txuam nrog kev pheej hmoo ntawm kev tuag ntxov ntxov los ntawm ntau yam mob thiab mob ntev. Kev tuag ntawm cov menyuam yaus thiab cov neeg laus uas muaj ntshav qab zib hom 1 feem ntau cuam tshuam nrog kev mob ntshav qab zib mob hnyav; lub caij no, lub ntsiab ua rau tuag nyob rau hauv cov neeg laus muaj feem xyuam rau cov teeb meem mus sij hawm ntev, tshwj xeeb tshaj yogkab mob plawv(CVD).Txawm hais tias qhov kev pheej hmoo ntawm kev tuag ntawm cov neeg mob ntshav qab zib hom 1 tseem nce siab, qhov kev poob qis hauv kev tuag ntawm cov neeg mob ntshav qab zib hom 1 tau pom nyob hauv ntau lub ntiaj teb, xws li Norway, Australia, thiab Sweden.Ib qho kev txheeb xyuas qhov kev pheej hmoo ntawm tus txheeb ze (RR) ntawm kev tuag rau hom 1 mob ntshav qab zib mellitus piv nrog cov pej xeem uas suav nrog 26 txoj kev tshawb fawb nrog 88 cov neeg nyob hauv qab pom tias tag nrho RR ntawm kev tuag yog 3.82 (95% kev ntseeg siab luv [CI], 3.41. -4.29) piv nrog cov pej xeem. Kev soj ntsuam siv cov ntaub ntawv ua ntej 1971 muaj qhov kwv yees loj dua RR (5.80) thaum piv nrog cov ntaub ntawv ntawm 1971 thiab 1980 (RR 5.06), 1981-1990 (RR 3.59), thiab cov tom qab 1990 (RR 3.11). Tsis ntev los notxhim kho kev tuaglos ntawm hom 1 mob ntshav qab zib mellitus feem ntau yog los ntawm kev tswj hwm cov txheej txheem uas hais txog kev tswj glycemic nruj, tswj ntshav siab, thiabkev kho mob ntawm dyslipidemia, nrog rau kev haus luam yeeb, hauv kev tswj cov ntshav qab zib hom 1.
NATURAL CISTANCHE TUBULOSA FOR REATING DIABETES PHGS75% ECH 30% ACT 12%
Cov pov thawj tsis ntev los no qhia txog kev txo qis hauv kev tuag los ntawm cov teeb meem mob ntev, 8 tab sis kev hloov pauv me ntsis hauv kev tuag los ntawm cov teeb meem mob hnyav ntawm hom 1 mob ntshav qab zib mellitus.13 Cov neeg tuag sib txawv ntawm cov teb chaws, 4, thiab cov teb chaws uas muaj cov mob ntshav qab zib hom 1 tsawg dua thiab cov txheeb ze tuag. tshaj cov teb chaws uas muaj kev sib kis ntau dua.6,14 Willi et al15 tau hais qhia txog kev sib txawv ntawm haiv neeg hauv cov txiaj ntsig ntawm cov menyuam yaus uas muaj ntshav qab zib hom 1, nrog cov neeg koom nrog dub muaj ntshav qab zib ketoacidosis ntau dua thiab cov xwm txheej hypoglycemic hnyav dua li cov neeg koom nrog dawb lossis Hispanic. Kev tshuaj xyuas tsis ntev los no tau txheeb xyuas 16 qhov kev tshawb fawb uas pom tias haiv neeg tsawg= cov tub ntxhais hluas haiv neeg tsawg uas muaj ntshav qab zib hom 1 muaj hemoglobin A1c (HbA1c) ntau dua li cov tub ntxhais hluas Caucasian.16 Kev tshuaj xyuas tsis ntev los no tau qhia tias South Asian haiv neeg uas muaj ntshav qab zib hom 1 muaj kev tuag ntau dua. Cov neeg European dawb vim yog CVD ntau dhau. Hom 1 mob ntshav qab zib mellitus hauv South Asians kuj tseem muaj HbA1c siab dua, qis dua lipoprotein ntom ntom, thiab qis dua cov kab mob neuropathy dua li cov neeg European dawb.17
Hauv Taiwan, qhov tshwm sim txhua xyoo ntawm cov menyuam yaus (<15 years) type 1 diabetes was stable for boys and girls, with a mean annual incidence rate of 5.3 per 100,000 children between 2003 and 2008.18,19 Compared with Western countries, especially the Nordic nations, Taiwan is among the nations with a low incidence rate of type 1 diabetes. However, the mortality of individuals with type 1 diabetes in Taiwan has not been adequately studied. This study aimed to investigate the overall, sex-specific, and age-specific risks of mortality from all-cause and various causes among type 1 diabetes patients in 1998–2014.
Txoj kev
Txoj kev tshawb fawb no tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb ntawm National Cheng Kung University Tsev Kho Mob (No. B-EX- 105-010). Daim ntawv tso cai pom zoo raug zam vim qhov kev lees paub ntawm tus kheej.
Cov ntaub ntawv
Cov ntaub ntawv txheeb xyuas hauv txoj kev tshawb fawb no tau muab los ntawm cov ntaub ntawv ntawm National Health Insurance (NHI) program thiab Taiwan Death Registry (TDR) los ntawm 1998 txog 2014. NHI thov cov ntaub ntawv khaws cov neeg mob hauv tsev kho mob=cov neeg mob sab nraud thov ntawm txhua tus neeg nyob hauv Taiwan. , thiab NHI Administration ua cov kws tshaj lij kev tshuaj xyuas peb lub hlis twg ntawm ib qho piv txwv ntawm kev thov kho mob kom ntseeg tau tias lawv raug.
Peb tau siv ntau qhov chaw ntawm NHI daim ntawv thov cov ntaub ntawv, suav nrog Kev Tshawb Fawb Kev Mob Nkeeg (CID) thiab Cov Neeg Tau Txais Kev Sau Npe uas suav nrog cov yam ntxwv ntawm txhua tus neeg. Cov ntaub ntawv hais txog kev kuaj mob ntshav qab zib hom 1 yog ntawm cov kab mob loj heev hauv CID. Cov tib neeg uas tau sau npe hauv CID rau hom 1 mob ntshav qab zib yuav tsum tau tshaj tawm rau NHIA lub rooj saib xyuas tus kws kho mob daim ntawv pov thawj kuaj mob thiab cov ntaub ntawv kho mob cuam tshuam, suav nrog cov txiaj ntsig kev kuaj mob, yoo mov lossis glucagon-stimulated qib C-peptide, qib anti-GAD antibody, thiab keeb kwm ntawm mob ntshav qab zib ketoacidosis. Kev kuaj mob ntshav qab zib hom 1 hauv CID yav dhau los tau siv los qhia txog qhov tshwm sim ntawm hom 1 mob ntshav qab zib hauv Taiwan.18,19 nrog kev kwv yees zoo ntawm 98.3%.
Hauv Taiwan, txhua qhov kev yug menyuam thiab tuag yuav tsum tau sau npe hauv 10 hnub tom qab yug los lossis tuag raws li txoj cai lij choj. Daim ntawv pov thawj kev tuag muaj ntau yam ntaub ntawv, suav nrog cov pej xeem sib txawv, qhov ua rau tuag (UCOD), qhov chaw tuag, thiab kev txij nkawm. Cov ntaub ntawv zoo rau TDR tau raug tshuaj xyuas thiab suav tias yog siv tau thiab ua tiav.
Kawm tsim qauv
Peb tau siv cov qauv kev tshawb fawb rov qab uas tau pib suav nrog 17,269 tus neeg mob ntshav qab zib hom 1 uas tau sau npe nrog CID thaum xyoo 1998 thiab 2014. Tom qab tsis suav nrog 66 tus neeg mob uas tsis muaj ntaub ntawv qhia txog poj niam txiv neej lossis hnub nyoog ntawm CID sau npe, txoj kev tshawb no tau sau npe 17,203 txoj kev kawm. Hnub ntawm kev sau npe CID raug suav tias yog hnub ntawm kev sau npe kawm hauv pawg neeg (piv txwv li, pawg neeg nkag).
Cov neeg mob txoj kev tshawb fawb tau txuas nrog TDR siv tus lej cim tus kheej tshwj xeeb los txheeb xyuas cov neeg mob uas tuag thaum lub sijhawm kawm xyoo 1998-2014. Cov ntaub ntawv ntawm UCOD yog raws li International Classification of Diseases, Ninth Revision Clinical Modification (ICD-9-CM) (1998–2007) lossis Kaum Ib Hlis (ICD-10-CM) (2008–2014) cov lej. Hauv 17 xyoo ntawm kev soj ntsuam, 4,916 tus neeg tuag, suav nrog 2,511 txiv neej thiab 2,405 tus poj niam.
NATURAL CISTANCHE TUBULOSA FOR Preventing Diabetes PHGS75% ECH 30% ACT 12%
Kev txheeb cais
Cov neeg-xyoo tau soj ntsuam rau txhua qhov kev kawm tau sau los ntawm hnub ntawm kev sau npe koom nrog rau hnub tuag lossis hnub kawg ntawm 2014. Hnub nyoog ntawm kev cuv npe tau muab faib ua 0–14, 15–29, 30–44, thiab Ntau dua lossis sib npaug rau 45 xyoo. Tus neeg-xyoo tau muab faib raws li xyoo, poj niam txiv neej, thiab tus neeg mob lub hnub nyoog ntawm cov xyoo sib txawv (ie, ua ntej 2003, 2003-2006, 2007-2010, thiab 2011-2014). Cov pab pawg tshawb fawb tau pab 182,523 tus neeg-xyoo nyob rau lub sijhawm taug qab. Cov neeg tuag tau raug xam raws li tus naj npawb ntawm cov neeg tuag muab faib los ntawm cov neeg soj ntsuam-xyoo. Ciaj sia taus nkhaus rau kev sib deev-stratified thiab hnub nyoog-stratified cumulative survival kev pheej hmoo tau npaj siv Kaplan-Meier cov khoom txwv txoj kev thiab muab piv nrog kev ntsuas ntsuas ntsuas.
Peb muab piv rau cov neeg mob qhov kev pheej hmoo ntawm txhua qhov ua rau thiab qhov ua rau tuag rau cov neeg ntawm cov pej xeem uas sib piv nrog poj niam txiv neej thiab hnub nyoog ntawm cov xyoo tshwj xeeb. UCOD soj ntsuam hauv qhov kev tshawb fawb no suav nrog ntshav qab zib, kab mob hauv lub cev, mob qog noj ntshav, mob raum, mob hnyav thiab kev raug mob, tua tus kheej, kis kab mob, kab mob siab ntev lossis mob siab cirrhosis, thiab kab mob ntsws ntev (COPD). eTable 1 qhia cov lej rau cov xaiv UCOD txheeb xyuas hauv qhov kev tshawb fawb no.
Qhov xav tias muaj pes tsawg tus neeg tuag rau hom 1 mob ntshav qab zib hom 1 tau suav los ntawm tus neeg-xyoo mus kom ze uas siv cov hnub nyoog thiab poj niam txiv neej cov neeg tuag txhua xyoo, hais txog cov pej xeem ntawm Taiwan. Cov hnub nyoog txhua xyoo- thiab cov poj niam txiv neej qhov loj me rau cov pej xeem nyob rau lub sijhawm kawm tau muab los ntawm lub teb chaws txhua xyoo kev sau npe tsev neeg cov ntaub ntawv luam tawm los ntawm Ministry of Interior of Taiwan. Qhov nruab nrab txhua xyoo ntawm cov pejxeem nyob rau lub sijhawm kawm (piv txwv li, 1998-2014) yog 23,769,198. Zuag qhia tag nrho, kev sib deev tshwj xeeb, thiab hnub nyoog tshwj xeeb tus qauv kev tuag tus qauv (SMRs) raug xam. 95% CI rau SMR tau kwv yees siv qhov kev kwv yees.22 Cov kev faib tawm ntawm UCOD tau nthuav tawm raws li hnub nyoog ntawm kev cuv npe, poj niam txiv neej, thiab xyoo ntawm kev sib koom ua ke. Kev tshuaj xyuas tau ua tiav siv SAS (version 9.4; SAS Institute, Cary, NC, USA), thiab theem ntawm qhov tseem ceeb tau teeb tsa ntawm=0.05.
TSEEM CEEB
Cov pab pawg tshawb fawb suav nrog 7,696 qhov tshwm sim (44.74%) thiab 9,507 qhov xwm txheej (55.26%) cov neeg mob ntshav qab zib hom 1, nrog rau cov poj niam me ntsis. Qhov nruab nrab hnub nyoog ntawm kev sau npe kawm yog 33.05 (tus qauv sib txawv [SD], 21.41; nruab nrab, 28) xyoo. Txog li 17 xyoo ntawm kev soj ntsuam, 4,916 tus neeg mob tuag los ntawm qhov ua rau ntawm lub hnub nyoog nruab nrab ntawm 62.37 (SD, 16.68) xyoo. Ntawm cov neeg tuag, 65 (1.32%) tuag thaum muaj hnub nyoog<20 years and 2,556 (51.99%) died at 65 years or older (table 2). Cumulative survival risks were significantly different between males and females (P < 0.001, log-rank test) (Figure 1) and across ages at enrollment (P < 0.001, log-rank test) (Figure 2).
Mob ntshav qab zib yog tus thawj coj UCOD (n {{0}},482), uas suav txog 30.15% ntawm tag nrho cov neeg tuag, tom qab ntawd yog mob qog noj ntshav (n=1,007, 20.48%), cov kab mob circulatory ( n=646, 13.14%) thiab kab mob raum (n=563, 11.45%). Kev faib tawm ntawm UCODs sib txawv nrog lub hnub nyoog ntawm kev tuag, nyob rau hauv qhov kev faib ua feem ntawm cov neeg tuag los ntawm kev ua phem los yog xwm txheej (nrog rau kev tua tus kheej) thiab ntshav qab zib muaj ntau dua rau cov menyuam yaus (0-14 xyoo) ntau dua li cov neeg mob laus dua. Qhov feem pua ntawm cov neeg tuag los ntawm cov kab mob circulatory, kab mob raum, kab mob sib kis, thiab mob ntsws muaj ntau dua ntawm cov neeg mob uas muaj hnub nyoog ntau dua lossis sib npaug li 45 xyoo; qhov kev faib ua feem ntawm cov neeg tuag los ntawm cov kab mob circulatory nce nrog lub hnub nyoog (daim duab 1).
Kev faib tawm ntawm UCOD yog qhov tseem ceeb zoo sib xws ntawm cov txiv neej thiab poj niam cov ntsiab lus, nrog me ntsis ntau dua ntawm cov neeg tuag los ntawm mob qog noj ntshav tau sau tseg hauv cov txiv neej thiab ntshav qab zib tau sau tseg hauv cov poj niam (daim duab 2). Kev faib ua feem ntawm cov neeg tuag los ntawm cov kab mob circulatory thiab kab mob tau nce ntxiv nyob rau lub sijhawm kawm, tab sis feem ntau ntawm cov ntshav qab zib thiabCov kab mob siab ua kom tsawg tsawg(daim duab 3).
Kev tuag ntawm cov neeg mob ntshav qab zib hom 1 yog 26.93 rau 1,000 tus neeg-xyoo rau tag nrho pawg neeg mob, 29.25 rau 1,000 tus neeg-xyoo rau txiv neej, thiab 24.90 rau 1,{{ 14}} neeg-xyoo rau poj niam (Table 1). UCOD uas muaj cov neeg tuag ntau dua hauv cov neeg mob ntshav qab zib hom 1 yog ntshav qab zib, mob qog noj ntshav, thiab kab mob circulatory (8.12, 5.52, thiab 3.54 rau 1,000 tus neeg-xyoos, feem). Qhov ua rau tuag nrog cov neeg tuag ntau dua yog qhov zoo sib xws ntawm cov txiv neej thiab poj niam. Mob qog noj ntshav hauv lub siab thiab cov kab mob intrahepatic bile ducts yog UCOD nquag tshaj plaws ntawm cov npe ntawm cov qog nqaij hlav hauv cov txiv neej thiab poj niam.
Piv nrog rau cov pej xeem, cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus muaj qhov pheej hmoo ntawm kev tuag tag nrho (SMR 4.16; 95% CI, 4.04-4.28). Kev soj ntsuam tshwj xeeb qhia tau hais tias qhov nce SMR tshaj plaws tau pom rau ntshav qab zib (SMR, 16.45), tom qab los ntawm kab mob raum (SMR, 14.48), kab mob siab ntev thiab mob siab cirrhosis (SMR, 4.91), kab mob (SMR, 4.59), thiab mob ntsws. (SMR, 3. 00). Cov kab mob qog noj ntshav thiab cov kab mob circulatory kuj pom muaj qhov nce SMR (SMR, 2.94 thiab 2.52, feem). Kev nce SMRs tau pom zoo rau cov kab mob hauv lub cev, suav nrog kab mob plawv, kab mob cerebrovascular, thiab kub siab yam tsis muaj kab mob plawv, nrog rau cov kab mob tshwj xeeb hauv chaw tshwj xeeb tshwj tsis yog raum neoplasm. Ntawm cov kab mob qog noj ntshav tshwj xeeb SMRs, SMR rau cov txiav txiav feem ntau tau nce ntawm 4.95. Mob ntshav qab zib hom 1 kuj tseem cuam tshuam nrog kev nce SMR rau kev ua phem thiab kev raug mob (SMR, 1.35) thiab COPD (SMR, 1.51) (Table 1).
SMRs tshwj xeeb ntawm kev sib deev kuj muaj nyob rau hauv Table 1. Txiv neej thiab poj niam hom ntshav qab zib hom 1 tau cuam tshuam nrog kev ua rau tag nrho cov neeg tuag nrog SMR ntawm 3.79 thiab 4.62, raws li. Ob tus txiv neej thiab poj niam cov neeg mob tau nce SMRs rau ntshav qab zib, mob raum, thiab mob qog noj ntshav. Txawm hais tias poj niam txiv neej thiab poj niam txiv neej tau cuam tshuam nrog kev nce SMRs ntawm cov kab mob ncig, kab mob, mob ntsws, mob siab, thiab mob siab, cov poj niam cov neeg mob muaj SMRs ntau dua ntawm cov ua rau saum toj no ntau dua li cov txiv neej.
Qhov kev tuag tag nrho thiab txhua qhov ua rau SMRs kuj tau nce ntxiv rau txhua lub hnub nyoog ntawm kev tso npe (Table 2). Qhov nce SMR tshaj plaws tau pom rau cov neeg mob hnub nyoog 15-29 xyoo (SMR, 8.46), tom qab hnub nyoog 3{{10}}-44 xyoo (SMR, 8.08) thiab 0-14 xyoo (SMR, 5.37); SMR yog qhov tsawg tshaj plaws rau cov neeg kawm hauv Greater dua lossis sib npaug rau 45 xyoo (SMR, 3.57). Kev nce SMRs tseem ceeb tau raug sau tseg rau cov kab mob ncig, mob qog noj ntshav, ntshav qab zib, thiab mob ntsws hauv txhua pab pawg hnub nyoog. Kev nce ntau ntawm SMR ntawm cov kab mob raum tau pom ntawm cov neeg mob hnub nyoog 15-29 xyoo (SMR, 98.86), 30-44 xyoo (SMR, 48.73), thiab Ntau dua lossis sib npaug rau 45 xyoo (SMR, 12.50 Nws.). SMRs ntawm kev kis kab mob siab ntev thiab mob siab ua rau mob siab kuj tseem nce ntxiv hauv peb pawg hnub nyoog thiab tau zoo sib xws ntawm cov neeg mob hnub nyoog siab dua lossis sib npaug li 45 xyoo. SMR ntawm ntshav qab zib yog qhov siab tshaj plaws hauv cov menyuam yaus hnub nyoog qis dua 0-14 xyoo thiab qis dua nrog hnub nyoog. SMR ntawm kev ua phem thiab kev sib tsoo tau nce ntxiv rau cov hnub nyoog 15-29 xyoo (SMR, 1.68), thiab SMR ntawm kev tua tus kheej tau nce ntxiv rau cov hnub nyoog 30-44 xyoo (SMR, 2.35). SMR ntawm COPD tsuas yog nce siab rau cov hnub nyoog Ntau dua lossis sib npaug li 45 xyoo (Table 2).
NATURAL CISTANCHE TUBULOSA rau kev txhim kho kev tiv thaiv kab mob PHGS75% ECH 30% ACT 12%
Kev sib tham
Cov kev tshawb pom tseem ceeb
Cancer suav txog 20.48% ntawm tag nrho cov neeg tuag, ua raws li cov kab mob circulatory (13.14%) thiab cov kab mob raum (11.45%) hauv peb cov qauv. Txhua qhov ua rau SMR tau nce siab ntawm 4.16, nrog ntau dua qhov ua rau SMR sau tseg hauv cov poj niam dua li cov txiv neej (4.62 vs 3.79). Mob ntshav qab zib thiab kab mob raum tau cuam tshuam nrog ntau qhov ua rau SMR tshwj xeeb hauv ob leeg poj niam txiv neej.
Zuag qhia tag nrho thiab ua rau kev tsom xam tshwj xeeb
Sib nrug los ntawm kev mob ntshav qab zib mob hnyav, mob qog noj ntshav yog tus thawj coj UCOD ntawm hom 1 mob ntshav qab zib hauv Taiwan, uas yog qhov sib txawv ntawm qhov kev tshawb pom ntawm cov kev tshawb fawb yav dhau los uas CVD tseem muaj ntau thiab ua rau muaj kev tuag ntxov ntxov hauv hom 1 ntshav qab zib.1,12,23 Hauv 27 xyoo tom qab. nkag mus rau hauv Kev Tshawb Fawb Kev Kho Mob Ntshav Qab Zib thiab Teeb Meem (DCCT), 107 tus neeg tuag tau sau tseg; feem ntau ua rau tuag yog CVD (22%), mob qog noj ntshav (20%), thiab mob hnyav (18%).12 Livingstone thiab al23 kuj pom tau tias kab mob plawv ischemic (IHD) feem ntau cuam tshuam nrog kev kwv yees poob hauv lub neej expectancy. Ntawm cov ntshav qab zib hom 1 (36% ntawm cov txiv neej, 31% ntawm cov poj niam). Txawm li cas los xij, kev tuag los ntawm kev mob qog noj ntshav kuj tshwm sim siab nyob rau hauv ob txoj kev tshawb fawb saum toj no.24 Qhov sib txawv ntawm kev faib tawm ntawm UCODs ntawm hom 1 mob ntshav qab zib tau qhia los ntawm cov kev tshawb fawb sib txawv yuav yog vim muaj cov kab mob sib txawv hauv cov kab mob sib txawv thoob plaws cov neeg sib txawv.
Tus neeg tuag (26.4 rau 1,000 tus neeg-xyoo) qhia hauv peb txoj kev tshawb fawb tau siab. Feem ntau ntawm cov kev tshawb fawb yav dhau los tau nrhiav cov xwm txheej hluas ntawm hom 1 mob ntshav qab zib hom 1 thiab ua raws li cov neeg koom nrog rau lawv peb caug xyoo, cov kev tshawb fawb tau tshaj tawm cov neeg tuag nyob ntawm 0.7 txog 6.75 rau 1,000 neeg-xyoos. .12,23,25–28 Peb txoj kev tshawb fawb tau soj ntsuam cov neeg mob uas muaj ntau, nrog rau cov hnub nyoog nruab nrab ntawm 33 xyoo ntawm kev tso npe, thiab pom tau 11 xyoo nyob rau nruab nrab. Lub hnub nyoog laus dua thiab ntev dua kab mob hauv peb cov kev kawm yuav ua rau muaj kev tuag ntau.
Txawm hais tias muaj peev xwm muaj teeb meem nrog kev sib piv SMRs, 29 qhov tsis sib xws hauv txhua qhov ua rau SMRs tau tshaj tawm hauv ntau lub teb chaws thiab cov pej xeem tau pom meej. Hauv Tebchaws Meskas, kev tuag hauv pawg DCCT cov kev kho mob ib txwm muaj ntau dua li cov pej xeem (SMR 1.31; 95% CI, 1.05–1.65). SMR 2.96; 95% CI, 2.29–3.82), 31 Brazil (SMR 3.13; 95% CI, 2.35–4.08), 32 thiab Wales (SMR 2.91; 95% CI, 1.96–4.15). hauv peb txoj kev tshawb fawb (SMR, 4.16) tau muab piv rau SMRs kwv yees los ntawm kev tshawb fawb Danish (SMR 4.8; 95% CI, 3.5–6.2) 26 thiab kev tshawb fawb ua hauv Yorkshire, United Kingdom (SMR 4.3; 95% CI, 3.8– 4.9).13 Qhov tsis sib xws hauv txhua qhov vim tias SMR kuj muaj nyob hauv ib lub tebchaws dhau sijhawm.5,6,27
Peb txoj kev tshawb fawb tau pom qhov SMR siab heev (14.48) rau mob raum. Mob ntshav qab zib mellitus yog suav tias yog qhov tshwm sim ntau tshaj plaws ntawm cov kab mob raum kawg (ESRD). Cov neeg mob ntshav qab zib mellitus thiab mob ntshav qab zib nephropathy muaj qhov cuam tshuam rau ntau yam kev kho mob ntau dua li cov uas tsis muaj ntshav qab zib nyob rau theem zoo sib xws ntawm cov mob raum. Cov neeg mob ntshav qab zib thiab mob raum mob kuj tseem pheej mus pw hauv tsev kho mob nrog kev kis kab mob thiab mob raum mob.33 Onda et al1 pom tias 36.3% ntawm 113 tus neeg tuag uas muaj ntshav qab zib hom 1 thiab ESRD muaj ESRD yog qhov ua rau tuag. Taiwan yog nyob rau hauv cov teb chaws uas muaj qhov tshwm sim siab (ntau ntawm 407-476 ib 106) thiab cov neeg muaj feem ntau (2,525-3,317 ib 106) ntawm ESRD nyob rau hauv lub ntiaj teb no ntawm 2008 thiab 2015.34 A disproportionally feem ntau ntawm ESRD nyob rau hauv cov neeg mob ntshav qab zib nyob rau hauv Taiwan thiab Taiwan. Kev sib koom siab siab ntawm ntshav qab zib thiab mob raum mob raum tuag yuav ua rau muaj SMR siab rau cov kab mob raum tau sau tseg hauv peb txoj kev tshawb fawb.
Kev tsom xam txog poj niam txiv neej
Peb txoj kev tshawb fawb tau sau tseg ntau dua qhov ua rau SMR hauv cov poj niam cov neeg mob ntau dua li cov txiv neej (4.62 vs 3.79). Piv nrog rau cov txiv neej, cov poj niam cov neeg mob muaj qhov ua rau SMR ntau dua rau cov kab mob circulatory (2.83 vs 2.24) thiab kab mob (6.08 vs 3.52) tab sis muaj SMRs piv rau mob qog noj ntshav (2.87 vs 2.99) thiab kab mob raum ( 14.06 vs 15.01 Nws. Ob qhov kev tshawb fawb Norwegian pom tias SMR rau txhua qhov ua tau zoo sib xws hauv ob qho tib si genders.6,27 Ntxiv rau, qhov sib txawv me ntsis ntawm kev sib deev hauv txhua qhov ua rau SMR tau pom nyob rau hauv UK txoj kev tshawb fawb uas tau tshaj tawm SMRs ntawm 4.4 (95% CI, 3.8–5.2. ) thiab 4.0 (95% CI, 3.2–5.2) rau txiv neej thiab poj niam, feem.13
Txawm hais tias muaj qhov tsis sib xws, Lung et al9 tau ua cov tshuaj ntsuam xyuas meta raws li 26 kev tshawb fawb thiab pom tias RRs ntawm tag nrho cov neeg tuag yog 3.25 (95% CI, 2.82-3.73) thiab 4.54 (95% CI, 3.79-5.45) rau cov txiv neej thiab poj niam, raws. Ib txoj kev tshawb fawb tsis ntev los no ua nyob rau hauv Northern Ireland los ntawm Morgan thiab al31 kuj pom tias cov poj niam muaj kev pheej hmoo ntawm kev tuag ntau dua li cov txiv neej nrog SMRs ntawm 5.35 (95% CI, 3.61-7.64) thiab 2.03 (95% CI, 1.36-2.91), raws. Harjutsalo et al35 tau tshuaj xyuas cov neeg tuag mus sij hawm ntev los ntawm IHD hauv pawg neeg Finnish uas muaj ntshav qab zib hom 1. Cov poj niam muaj SMR ntau dua li cov txiv neej, thiab qhov sib txawv ntawm SMR ntawm kev sib deev tau tshwm sim hauv cov poj niam thaum ntxov (poj niam: 52.8, 95% CI, 36.3-74.5; txiv neej: 12.1, 95% CI, 9.2-15.8).
Ib qho SMRs siab ntawm txhua qhov ua rau thiab cov hlab ntsha tuaj yeem yog vim qhov "catching-up" cuam tshuam rau cov poj niam tom qab muaj ntshav qab zib, txawm tias cov poj niam feem ntau muaj kev pheej hmoo tsawg dua ntawm txhua qhov ua rau thiab CVD kev tuag ntau dua li cov txiv neej rau ntau ntawm lawv lub neej. Ib qho kev soj ntsuam ntawm 214,114 hom 1 ntshav qab zib tau tshaj tawm tias cov poj niam-rau-txiv neej sib piv ntawm SMR yog 1.37 (95% CI, 1.21-1.56) rau tag nrho cov neeg tuag, 1.44 (95% CI, 1.02-2.05) rau kab mob raum, 1.86 (95% CI, 1.62–2.15) rau CVDs, thiab txawm ntau heev rau cov kab mob plawv (2.54, 95% CI, 1.80–3.60).36
Kev tsom xam hnub nyoog tshwj xeeb
Ib txoj kev tshawb fawb Norwegian los ntawm Gagnum et al6 tau soj ntsuam ib pawg neeg mob ntshav qab zib hom 1 thiab pom tias 249 (3.2%) tau tuag thaum lub sijhawm rov qab los ntawm 16.8 xyoo. SMR rau txhua qhov laj thawj yog 3.6 (95% CI, 3.1–4.0), uas tau nce los ntawm lub hnub nyoog.6 Txawm li cas los xij, qhov kev tshawb pom no tsis sib haum nrog peb qhov kev tshawb pom uas pom tias muaj SMR siab hauv cov hnub nyoog 15-29 xyoo.
Feem ntau cov kev tshawb fawb yav dhau los pom tias qhov ua rau tuag ua ntej hnub nyoog 30 xyoo yog qhov mob hnyav, thaum CVD yog qhov tseem ceeb tom qab hnub nyoog 30 xyoo. Txawm li cas los xij, kev tuag los ntawm kev mob hnyav, xws li kev kis kab mob, tseem tseem ceeb hauv txhua pab pawg hnub nyoog.5
Harjutsalo et al35 pom tias RR ntawm kev tuag los ntawm IHD yog qhov loj tshaj rau cov neeg mob hnub nyoog<40 years and 40–60 years in the early and late-onset cohorts, respectively. We used age at type 1 diabetes registration in CID rather than age at disease onset. Thus, the different age-specific SMRs cannot be compared straightforwardly since the risk of IHD in older prevalent cases was expected to be higher. However, our study showed significantly elevated SMR for suicide among patients aged 30–44 years and significantly elevated SMR for violence and accidents among patients aged 15–29 years. Associations between type 1 diabetes and psychiatric disorders among younger patients have been well documented.
Muaj zog thiab kev txwv
Txoj kev tshawb no ntawm cov pej xeem yog thawj zaug los tshawb xyuas qhov ua rau tuag hauv cov neeg Esxias uas muaj qhov tshwm sim tsawg ntawm hom 1 ntshav qab zib. Kev siv cov ntaub ntawv thov kev kho mob hauv tebchaws thiab kev sau npe tuag ua kom cov neeg sawv cev ntawm cov neeg mob ntshav qab zib hom 1 thiab kev lees paub tiav ntawm cov neeg tuag. Hom 1 mob ntshav qab zib mellitus loj txaus ntawm cov pej xeem tseem pab txhawb kev tshawb fawb txog hnub nyoog thiab kev sib deev tshwj xeeb yam tsis muaj kev cuam tshuam txog lub zog ntawm cov ntaub ntawv.
Txawm li cas los xij, peb cov qauv kev tshawb fawb tau sib xyaw nrog cov xwm txheej thiab qhov tshwm sim ntawm cov mob ntshav qab zib hom 1, uas sib xyaw lub tswv yim ntawm kev tshwm sim thiab kev ciaj sia thiab ua rau nyuaj rau kev sib piv peb cov txiaj ntsig nrog cov kev tshawb fawb yav dhau los uas feem ntau pib ua raws li hnub ntawm kev kuaj mob ntshav qab zib hom 1. . Lwm qhov kev txwv yog qhov tsis muaj kev kho kom tiav rau qhov muaj peev xwm prognostic yam tom qab mob ntshav qab zib hom 1, xws likev kho mob thiab kev ua neej nyob, uas kuj txwv qhov kev txhais lus ntawm peb txoj kev tshawb fawb. Thaum kawg, cov ntaub ntawv tseem ceeb hauv peb txoj kev tshawb fawb tau qhia tias ntshav qab zib yog UCOD ntawm cov neeg tuag nrog hom 1 mob ntshav qab zib yam tsis muaj ntaub ntawv ntxiv, qhov tsis paub meej ntawm qhov tsis zoo yuav ua rau cov txheeb cais ntawm UCOD. Txawm li cas los xij, peb ntseeg tias UCOD ntawm cov ntaub ntawv no feem ntau cuam tshuam nrog cov teeb meem mob ntshav qab zib mellitus uas tsis tshua muaj npe raws li UCOD thiab yuav tsum tau kwv yees ntau hauv peb txoj kev tshawb fawb.
Tshaj li 17 xyoo ntawm kev soj ntsuam, cov neeg mob uas muaj ntshav qab zib hom 1 hauv Taiwan tau ntsib kev tuag ntau ntxiv los ntawm txhua qhov laj thawj thiab ntau yam UCODs. Mob qog noj ntshav suav nrog cov neeg tuag coob tshaj plaws, thaum lub raum kab mob cuam tshuam nrog qhov loj tshaj plaws thiab nce siab SMR. Sib nrug los ntawm ib txwm lees paub ua rau kev tuag cuam tshuam nrog hom 1 mob ntshav qab zib mellitus, xws li CVDs thiab mob qog noj ntshav, qee yam UCODs, xws li kab mob siab ntev lossis mob siab ua rau mob siab thiab COPD hauv cov neeg laus, nrog rau kev sib tsoo thiab kev tua tus kheej hauv cov neeg mob hluas kuj tseem cuam tshuam nrog hom. 1 mob ntshav qab zib. Cov kws kho mob yuav tsum xav txog qhov tshwj xeeb UCOD hauv kev xa khoomkev kho mob thiab kev noj qab haus huvsaib xyuas cov neeg mob ntshav qab zib hom 1.
NATURAL CISTANCHE TUBULOSA RAU RELIVING DIABETES PHGS75% ECH 30% ACT 12%
