新诊断2型糖尿病表型的演变：一项15年基于人群的比较研究
本研究基于以色列Clalit医疗服务电子病历数据，比较2005-2008年（n=80,201）与2020-2023年（n=101,392）新诊断2型糖尿病成年患者的表型及早期治疗特征。结果显示，诊断年龄中位数从63.0岁升至66.7岁，合并症负担加重，HbA1c和LDL胆固醇水平降低，SGLT2抑制剂和GLP-1受体激动剂使用增加，磺脲类使用减少。结论：表型已发生根本性重构，需年龄适宜的管理策略。
要点
- 诊断年龄增加，≥85岁比例从3.5%升至6.6%。
- 诊断时HbA1c从56降至53 mmol/mol（7.3%至7.0%）。
- SGLT2抑制剂使用从0.07%升至15.0%，磺脲类降至4.5%。
核心结论
- 新诊断2型糖尿病的表型自2008年以来发生根本性重构：患者年龄更大、合并症负担更高，但血糖和血脂控制更好，后者反映了诊断前已建立的他汀治疗。
- MASLD成为主要合并症，但部分受诊断手段影响。
- 治疗转向SGLT2抑制剂和GLP-1受体激动剂，提示治疗范式从以血糖为中心转向心肾和体重驱动。
研究设计与样本
- 回顾性队列研究，使用电子健康记录数据。
- 数据来自以色列Clalit医疗服务（Haifa & Western Galilee）。
- 比较2005-2008年（n=80,201）与2020-2023年（n=101,392）新诊断2型糖尿病成人。
主要发现
- 诊断时中位年龄从63.0岁增加至66.7岁；≥85岁比例从3.5%增至6.6%。
- Charlson合并症指数中位数从4增至6（SMD 0.48）。
- MASLD患病率从4.4%增至18.6%。
- 诊断时HbA1c从56 mmol/mol（7.3%）降至53 mmol/mol（7.0%）。
- 诊断前LDL胆固醇从2.90降至2.21 mmol/l（SMD 0.65）。
关键数值与推荐
- SMD值≥0.20表示至少小效应（用于量化组间差异）。
- 使用年龄分层敏感性分析和非参数检验及χ2检验。
- 文中未提及指南或共识推荐条款。
临床怎么用
- 需根据患者年龄调整管理策略，并开展纳入高龄老年人的临床试验。
- 治疗选择应更加注重心肾和体重获益，而非单纯降糖。
- MASLD的识别需考虑诊断手段的影响。
局限性
- 文中未报告具体局限性，但为回顾性观察研究，可能存在混杂因素。
- 基于单一医疗系统，可能限制外部推广性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
AIMS/HYPOTHESIS: Our aim was to describe the phenotype at diagnosis and the early therapeutic profile of newly diagnosed type 2 diabetes across two periods spanning approximately 15 years within the same integrated healthcare system.
METHODS: This retrospective cohort study used electronic health record data from Clalit Health Services (Haifa & Western Galilee, Israel). Adults with incident type 2 diabetes in 2005-2008 (period 1: n=80,201) were compared with those diagnosed in 2020-2023 (period 2: n=101,392). Between-period differences are presented as crude estimates, with an age-stratified sensitivity analysis, and quantified using standardised mean differences (SMDs; values ≥0.20 indicate at least a small effect) alongside non-parametric and χ2 tests.
RESULTS: The median age at diagnosis increased from 63.0 to 66.7 years between the two periods; the proportion aged ≥85 years nearly doubled (from 3.5% to 6.6%). The score for the Charlson comorbidity index increased from 4 to 6 (SMD 0.48); metabolic dysfunction-associated steatotic liver disease (MASLD) increased from 4.4% to 18.6%. HbA1c at diagnosis decreased from 56 to 53 mmol/mol (7.3% to 7.0%); pre-diagnosis LDL-cholesterol decreased from 2.90 to 2.21 mmol/l (SMD 0.65). Within 31-90 days of diagnosis, use of sodium-glucose cotransporter 2 (SGLT2) inhibitors increased from 0.07% to 15.0%, use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) increased from 0% to 11.1%, and sulfonylurea use decreased more than fourfold (20.8% to 4.5%).
CONCLUSIONS/INTERPRETATION: The phenotype of newly diagnosed type 2 diabetes has been fundamentally restructured since 2008: patients are older with a higher comorbidity burden but present with better glycaemic and lipid management, with the latter reflecting statin therapy already established before diagnosis. MASLD has emerged as a major but largely ascertainment-driven comorbidity. The shift to SGLT2 inhibitors and GLP-1RAs alongside declining sulfonylurea use indicates displacement of glucose-centric strategies by a cardiorenal- and weight-driven paradigm. These findings indicate a need for age-appropriate management and trials enrolling very elderly patients.
引用
- Kirshner, Hauzer. Evolving phenotype of newly diagnosed type 2 diabetes: a 15-year population-based comparison. Diabetologia. 2026. PMID: 42886236. doi:10.1007/s00125-026-06901-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。