AIMS/HYPOTHESIS Preterm birth (gestational age <37 weeks) has been associated with insulin resistance early in life. However, no large population-based studies have examined risks of type 1 and type 2 diabetes and potential sex-specific differences from childhood into adulthood. Clinicians will increasingly encounter adults who were born prematurely and will need to understand their long-term risks. We hypothesised that preterm birth is associated with increased risks of type 1 and type 2 diabetes into adulthood. METHODS A national cohort study was conducted of all 4,193,069 singletons born in Sweden during 1973-2014, who were followed up for type 1 and type 2 diabetes identified from nationwide diagnoses and pharmacy data to the end of 2015 (maximum age 43 years; median age at the end of follow-up 22.5 years). Cox regression was used to adjust for potential confounders, and co-sibling analyses assessed the influence of shared familial (genetic and/or environmental) factors. RESULTS In 92.3 million person-years of follow-up, 27,512 (0.7%) and 5525 (0.1%) people were identified with type 1 and type 2 diabetes, respectively. Gestational age at birth was inversely associated with both type 1 and type 2 diabetes risk. Adjusted HRs for type 1 and type 2 diabetes at age <18 years associated with preterm birth were 1.21 (95% CI, 1.14, 1.28) and 1.26 (95% CI, 1.01, 1.58), respectively, and at age 18-43 years were 1.24 (95% CI, 1.13, 1.37) and 1.49 (95% CI, 1.31, 1.68), respectively, compared with full-term birth. The associations between preterm birth and type 2 (but not type 1) diabetes were stronger among females (e.g. at age 18-43 years, females: adjusted HR, 1.75; 95% CI, 1.47, 2.09; males: 1.28; 95% CI, 1.08, 1.53; p < 0.01 for additive and multiplicative interaction). These associations were only partially explained by shared genetic or environmental factors in families. CONCLUSIONS/INTERPRETATION In this large national cohort, preterm birth was associated with increased risk of type 1 and type 2 diabetes from childhood into early to mid-adulthood. Preterm-born children and adults may need early preventive evaluation and long-term monitoring for diabetes.

中文翻译：

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一项全国队列研究表明，早产和1型和2型糖尿病的风险。

目的/假设早产（胎龄<37周）与生命早期的胰岛素抵抗有关。然而，没有一项基于人群的大型研究检查过1型和2型糖尿病的风险以及从儿童期到成年期的潜在性别差异。临床医生将越来越多地遇到早产的成年人，并且需要了解其长期风险。我们假设早产与成年后1型和2型糖尿病的风险增加有关。方法进行了一项全国队列研究，调查了1973-2014年间在瑞典出生的所有4,193,069个人，对从全国诊断和药房数据确定的1型和2型糖尿病进行了随访，直至2015年底（最大年龄43岁；中位年龄随访22.5年结束时）。使用Cox回归来调整潜在的混杂因素，并且同级兄弟分析评估了共享的家族（遗传和/或环境）因素的影响。结果在9,230万人年的随访中，分别确定1型和2型糖尿病患者为27,512（0.7％）和5525（0.1％）人。出生时的胎龄与1型和2型糖尿病风险呈负相关。与早产相关的18岁以下的1型和2型糖尿病的校正后HRs分别为1.21（95％CI，1.14、1.28）和1.26（95％CI，1.01、1.58）和18-43岁与足月出生相比，分别为1.24（95％CI，1.13、1.37）和1.49（95％CI，1.31、1.68）。早产与2型（而非1型）糖尿病之间的关联在女性（例如18-43岁，女性：调整后的HR为1.75；95％CI，1.47、2.09；男性：1.28；95％CI，1.08，1.53；对于加性和乘性相互作用，p <0.01）。这些关联仅由家庭中共同的遗传或环境因素来部分解释。结论/解释在这个庞大的国家队列中，早产与从儿童期到成年中早期的1型和2型糖尿病风险增加有关。早产儿和成人可能需要早期预防性评估和对糖尿病的长期监测。从儿童期到成年中早期，早产与1型和2型糖尿病的风险增加相关。早产儿和成人可能需要早期预防性评估和对糖尿病的长期监测。从儿童期到成年中早期，早产与1型和2型糖尿病的风险增加相关。早产儿和成人可能需要早期预防性评估和对糖尿病的长期监测。