Introduction Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease. Research design and methods This was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry. Results A total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05). Conclusion Diabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes. Data are available on reasonable request. As the study involves human participants, the data cannot be made freely available in the article or a public repository owing to ethical restrictions. Nevertheless, the data are available from the Singapore Eye Research Institutional Ethics Committee for researchers who meet the criteria for access to confidential data. Interested researchers can send data access requests to the Singapore Eye Research Institute at seri@seri.com.sg.

中文翻译：

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2 型糖尿病和微血管并发症对亚洲多民族人群死亡率和心血管结局的影响


简介 糖尿病是亚洲日益严重的公共卫生流行病。我们研究了 2 型糖尿病、血糖控制和微血管并发症对无心血管病史的多种族亚洲人队列的死亡率和心血管结局的影响。研究设计和方法 这是一项在新加坡进行的前瞻性人群队列研究，参与者来自亚洲三大族群：华人、马来人和印度人，基线检查时间为 2004 年至 2011 年。基线时患有 1 型糖尿病和心血管疾病的参与者被排除在外。在基线时定义 2 型糖尿病、糖化血红蛋白 (HbA1c) 水平和微血管并发症（糖尿病视网膜病变和肾病）的存在。主要结局是全因死亡率和主要不良心血管事件（MACE），定义为心血管死亡率、心肌梗死、中风和血运重建的综合数据，通过国家登记处收集。结果 总共纳入 8541 名受试者，其中 1890 名基线时患有 2 型糖尿病。受试者的随访时间中位数为 6.4 (IQR 4.8–8.8) 年。糖尿病是死亡率（调整后 HR 1.74，95% CI 1.45 至 2.08，p<0.001）和 MACE（调整后 HR 1.64，95% CI 1.39 至 1.93，p<0.001）的显着预测因子。在糖尿病患者中，较高的 HbA1c 水平与 MACE 发生率增加相关（调整后 HR（每增加 1%）1.18，95% CI 1.11 至 1.26，p<0.001），但与死亡率无关（p=0.115）。与仅有任一微血管并发症（调整后的 p<0.05）和没有微血管并发症（调整后的 p<0.05）的受试者相比，患有两种微血管并发症的受试者的死亡率和 MACE 显着更高。 结论 对于既往无心血管疾病的亚洲患者来说，糖尿病是死亡率和心血管发病率的重要预测因素。在 2 型糖尿病患者中，血糖控制较差与 MACE 增加相关，但与死亡率无关。微血管并发症的负担更大，导致一部分患者的预后较差。可根据合理要求提供数据。由于该研究涉及人类参与者，由于道德限制，数据无法在文章或公共存储库中免费提供。尽管如此，符合获取机密数据标准的研究人员可以从新加坡眼科研究机构伦理委员会获得这些数据。有兴趣的研究人员可以通过seri@seri.com.sg向新加坡眼科研究所发送数据访问请求。