| Background and Objective: Patients with diabetes mellitus live shorter than without.With our increase in knowledge and management advances for diabetes,lifespan of patients with diabetes extends much longer,but still most patients with diabetes suffer from life threatening complications and die early.In order to find out what might be the favorable factor(s)that promote healthy long life in patients with diabetes,patients with duration of diabetes longer than 30 years was included,and clinical characteristics were compared between those with duration of longer than 30 years and those shorter,between those with chronic complications and those without in those with duration of diabetes longer than 30 years.Methods: Eighty-nine patients with type 2 diabetes with duration of diabetes longer than 30 years were retrieved from patients with diabetes hospitalized in author’ hospital from January 2012 to December 2016 after excluding Type 1 diabetes,gestational diabetes,patients with emergency.365 patients with type 2 diabetes of duration less than 30 years selected from ten cases after the index case of long duration as the control group and excluding those with type 1 diabetes,gestational diabetes and patients with emergency.The patients with long duration were further divided into those with chronic complications.Clinical and laboratory data were retrieved and were compared between those with 30 years of duration and shorter,between those with retinopathy and without,or between those with nephropathy and without,or between those with atherosclerosis and without,or between those with all chronic complications and without any.SPSS software(ver.22.0,IBM,USA)was used for statistics analysis.Results:1.Patients with diabetes duration of longer than 30 years(DD30 group)(with diabetes duration of 30-32years)with was older(75.8±7.2years)compare with shorter duration(SD group,60.6±12.6 years)(with duration of 4-16 years)(P<0.001),Age of diabetes onset(AO)was younger in DD(43.6±8.8 years)than in SD(50.4±11.82 years)(P<0.001);Hb A1 c was lower in DD30(8.51±1.66%)than in SD(9.18±2.42%)(P=0.003),Total cholesterol(TC)was borderline lower in DD30(4.71±1.18mmol/L)than in SD(4.98±1.30mmol/L,P=0.08),e GFR was lower in DD30(25%-75% :54.5ml/min-88.5ml/min)than in SD(25%-75%:88ml/min-98ml/min)(P<0.001).More patients with retinopathy(DR),nephropathy(DN),and history of cardiovascular diseases(CVD)were found in DD30 than in SD,and no significant differences were found for family history(FH),history of malignancy,sex,body mass index(BMI),fasting glucose(FBG),HDL-C,and LDL-C)(P>0.05).2.Eight cases(DD30NC)without DR,DN and CVD were found in DD30 patients.Patients in DD30 NC group had lower SBP(135.0±21.7 vs 153.3±22.6,P=0.031),lower BMI(22.57±1.38 kg/m2 vs 26.27±3.66 kg/m2,P=0.006),lower TG(25%-75%:0.93-1.50mmol/Lvs1.13-2.18mmol/L,P=0.017),lower UAE(6.84-19.89vs30.99-173.70,P<0.001)than in DD30 with any of the above mentioned chronic complications(DD30C),and TC was borderline lower in DD30NC(4.00±0.74 vs 4.79±1.19,P=0.073).No significant differences were found for age,AO,DD,diastolic blood pressure(DBP),FH,FBG,Hb A1 c,HDL-C,LDL-C,and e GFR(P>0.05).3.As cardiovascular diseases are the main cause of shortening of lifespan in t2 dm,DD30 patients were subdivided into those with CVD history(DD30CVD,n=28)and those without(DD30NCVD,n=60)groups.Compared with DD30 CVD,the only difference was DD30 NCVD patients was younger(P=0.028).No significant differences were found for AO,SBP,DBP,BMI,FH,FBG,Hb A1 c,TC,TG,HDL-C,LDL-C,UEA,e GFR,frequency of DR,DN(P>0.05).4.For comparison between patients with DR(DD30DR,n=66)and without(DD30NDR,n=23)in DD30 patients,only BMI(26.35±3.70 kg/m2 vs 24.57±3.32 kg/m2,P=0.066)was found borderline different between the two groups.No significant differences were found for sex,Age,AO,DD,FH,SBP,DBP,FBG,Hb A1 c,TC,TG,HDL-C,LDL-C,UAE,e GFR,frequency of CVD(P>0.05).5.Patients with diabetic nephropathy(DD30DN)were older(77.17±6.11 years)than those without(DD30NDN)(72.50±8.63 years)(P=0.005),The AO was older in DD30DN(45.44±6.79 year)than in DD30NDN(38.96±11.16 year)(P=0.001),but DD was shorter in DD30DN(30 years)than in DD30NDN(30-39)(P=0.016).SBP(158.2±21.9 vs 135.8±17.5),TG(25%-75%:1.21-2.20 vs 0.097-1.71),UAE(25%-75%:82.1-683.4mg/24 h vs 6.3-18.3 mg/24h)were higher,and e GFR(25%-75%:45.0-87.0ml/min vs 74.8-92.0 ml/min)was lower in NN30 DN than in DD30NDN(P<0.05).No significant differences were found for sex,FH,frequency of CVD,DBP,FBG,Hb A1 c,TC,HDL-C,LDL-C(P>0.05).Conclusions:The age of diabetes onset in patients with diabetes duration of longer than 30 years is younger,Hb A1 c and cholesterol control is better than patients with shorter duration of diabetes.Chronic complications are more often.No different in FH,malignancy,sex preference,BMI,and other lipid indexes compared with patients with shorter duration.Very few people in patients with diabetes duration of longer than 30 years is free of chronic complications.In those group of patients free of chronic complications has lower body weight,lower blood pressure,lower TG,borderline lower cholesterol.For any cardiovascular diseases the only risk factor is age,for diabetic retinopathy the only risk factor is borderline higher BMI,for diabetic nephropathy,defined as albuminuria,risk factors are older age,older age of diabetes onset,shorter duration of diabetes,higher blood pressure,higher BMI and higher TG. |
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