第49届糖尿病研究欧洲协会年会(EASD2013)于9月23-27日在西班牙巴塞罗那召开。当地时间9月25日下午，在“
既往研究证实，1型糖尿病患者的近期和远期并发症死亡率增加。另外，其他研究也表明在普通人群中，有后代的男性和女性相比，没有后代的男性和女性与死亡率更高。比普通人群相比，儿童期发病的1型糖尿病男性和女性患者的后代相对较少。本研究比较儿童期发病的1型糖尿病患者与对照组普通人群，将重点探讨没有后代和已有后代的患者在死亡率上的差别。
结果表明，随访至2010年年底，共有1025名糖尿病患者和497名非糖尿病患者死亡。糖尿病患者的全因死亡率明显高于对照组：糖尿病组男性患者的全因死亡率是对照组男性的3倍，糖尿病组女性患者的全因死亡率是对照组女性的5倍。无论在糖尿病组还是对照组，男性的死亡率均高于比女性。但糖尿病组男性与女性的死亡率差异小于对照组，说明糖尿病缩小了性别之间的死亡差异。Sjǒberg博士解释说：“虽然糖尿病使女性死亡率增加，但并不意味着女性患者的全因死亡率也增加。”
研究发现，总体来说，生育后代越多，死亡率越低，但是这种趋势在女性中更明显。在试验组和对照组以及两性之间，有后代的人群全因死亡率减半。在女性糖尿病和非糖尿病人群中，生育降低了死亡率。而在男性中，这种差异并不明显。
研究者观点
Sjǒberg博士表示，已发现生育可以降低死亡率，这种作用在男性中甚微，但在女性中，在不考虑糖尿病病情的前提下，生孩子可以降低死亡率。性别之间存在差异的可能原因是女性1型糖尿病患者在怀孕期间能够更好地控制代谢状态，而且可持续到产后。
该研究也存在一定的局限性，身体状况极差的患者会选择不生育也可能是死亡率存在差异的原因之一。
| Mortality and having offspring in type 1 diabetes（生育后代与1型糖尿病患者的死亡率） |
| Background and aims: Type 1 diabetes is associated with increased mortality compared with the general population, from both acute and long-term diabetic complications. Previous studies have shown that mortality in the general population is higher among women and men who do not have any offspring than among those who have children. Both men and women with childhood-onset type 1 diabetes have fewer offspring than the general population. Our aim was to examine mortality and causes of death among subjects with childhood-onset type 1 diabetes compared to control people, with focus on mortality differences between childless people and those having had offspring. Materials and methods: The people with diabetes in our study comprise the Finnish DERI cohort (Diabetes Epidemiology Research International). They were all diagnosed with diabetes at 17 years of age or under during 1965-1979 and placed on insulin at diagnosis. 5,162 cases were identified nationwide with an ascertainment rate approaching 100 percent; 2,327 of them were women. Two non-diabetic control persons for each person in the DERI cohort were selected from the database of the national Social Insurance Institution, matched for the year of birth, geographical birth region and gender. This register-based study uses information on the offspring from the national Population Register Centre. All statistical analyses were done using Cox proportional hazards model. Results: 1,025 people with diabetes and 497 people without diabetes died during the follow-up until the end of 2010. All-cause mortality in people with diabetes was significantly higher than that of control persons, both among men and women (p>0.01). All-cause mortality was statistically significantly lower in persons who had offspring (p<0.01), among both cases and controls, and in both genders. Among females, having children lowered mortality in a similar way in diabetic persons and controls (p=0.99 for interaction). In males, the difference in the shapes of the mortality curves by the number of offspring was statistically significant between diabetic and control people (p<0.01 for interaction). Conclusion: The beneficial effect of having offspring on mortality was observed. It was, however, significantly smaller among men with diabetes than among men in the control group. In women, having offspring was associated with lower mortality in a similar way regardless of the diabetes status. One possible reason for this gender difference is that women with type 1 diabetes are trained and well motivated to achieve better metabolic control during pregnancy and that this motivation may persist also post partum. |
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