Table_1_Intensity of Glycemic Exposure in Early Adulthood and Target Organ Damage in Middle Age: The CARDIA Study.DOCX

AimTo determine whether long-term intensity of glycemic exposure (IGE) during young adulthood is associated with multiple target organs function at midlife independent of single fasting glucose (FG) measurement.
MethodsWe included 2,859 participants, aged 18–30 years at Y0, in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. IGE was calculated as the sum of (average FG of two consecutive examinations × years between the examinations) over 25 years. Target organs function was indicated by cardiac structure, left ventricular (LV) systolic function, LV diastolic function, coronary artery calcium (CAC), and urine albumin-to-creatinine ratio (UACR) at Y25. We evaluated the associations between IGE with target organs function using linear regression models and estimated the associations between IGE with numbers of organs involved (0, 1, or ≥ 2 organs) using multinomial logistic regression models.
ResultsA 1-SD increment of IGE was significantly associated with worse target organs function after multivariable adjustment: left ventricular mass (β [SE], 5.468 [1.175]); global longitudinal strain (β [SE], 0.161 [0.071]); E/e’ ratio (β[SE], 0.192 [0.071]); CAC score (β [SE], 27.948 [6.116]); and log UACR (β [SE], 0.076 [0.010]). Besides, IGE was independently associated with having ≥ 2 organs involved in both overall population (OR [95% CI], 1.48 [1.23, 1.41], P < 0.001) and subgroups stratified by diabetes at Y25.
ConclusionHigher intensity of glycemic exposure during young adulthood was independently associated with subclinical alterations of target organs function at midlife. Our findings highlight the importance of early screening and management of IGE in youth.

研究目的：本研究旨在明确青年时期长期血糖暴露强度（glycemic exposure intensity, IGE）与中年时期多靶器官功能的相关性是否独立于单次空腹血糖（fasting glucose, FG）检测结果。
方法：本研究纳入青年冠状动脉风险发展研究（Coronary Artery Risk Development in Young Adults, CARDIA）中2859名基线（Y0）年龄为18~30岁的参与者。IGE的计算方式为25年间每两次连续随访的平均空腹血糖值乘以两次随访间隔年数的总和。靶器官功能通过第25年随访（Y25）时的心脏结构、左心室（left ventricular, LV）收缩功能、左心室舒张功能、冠状动脉钙化（coronary artery calcium, CAC）以及尿白蛋白肌酐比（urine albumin-to-creatinine ratio, UACR）进行评估。本研究采用线性回归模型分析IGE与靶器官功能的相关性，并采用多项逻辑回归模型评估IGE与受累器官数量（0个、1个或≥2个）的相关性。
结果：经多变量校正后，IGE每升高1个标准差，靶器官功能出现显著恶化：左心室质量（β值[标准误]：5.468[1.175]）、整体纵向应变（β值[标准误]：0.161[0.071]）、E/e’比值（β值[标准误]：0.192[0.071]）、冠状动脉钙化评分（β值[标准误]：27.948[6.116]）以及对数转换尿白蛋白肌酐比（β值[标准误]：0.076[0.010]）均存在显著不良变化。此外，在全人群以及第25年随访时按糖尿病状态分层的亚组中，IGE均与受累器官≥2个的情况独立相关（比值比[95%置信区间]：1.48[1.23, 1.41]，P<0.001）。
结论：青年时期更高的血糖暴露强度与中年时期靶器官功能的亚临床改变独立相关。本研究结果凸显了青年人群早期筛查与干预血糖暴露强度的重要性。