糖尿病慢性并发症与不良结局关联的研究进展
Research Progress on the Association between Chronic Diabetes Complications and Adverse Outcomes
摘要: 近三十年来,全球糖尿病患病率呈现显著上升趋势。根据世界卫生组织的数据,糖尿病患者人数在不断增长,这不仅对公共健康构成重大挑战,也对社会经济造成巨大负担。糖尿病患者发病年龄提前,病程延长,若长期处于高血糖状态,容易引发多种并发症。不仅会影响患者的生活质量,还可能导致严重的健康问题,甚至危及生命。因此,在这篇综述中,我们重点讨论糖尿病慢性并发症与不良结局之间关联的研究的新进展,并总结如何对糖尿病并发症进行预防和控制。
Abstract: Over the past three decades, the global prevalence of diabetes has shown a significant upward trend. According to data from the World Health Organization, the number of diabetes patients is constantly increasing, which not only poses a major challenge to public health but also imposes a huge burden on the social economy. The onset age of diabetes patients is earlier, and the disease duration is longer. If they remain in a state of high blood sugar for a long time, it is prone to trigger various complications. This not only affects the quality of life of patients but also may lead to serious health problems and even endanger life. Therefore, in this review, we focus on discussing the new progress in research on the association between chronic complications of diabetes and adverse outcomes, and summarize how to prevent and control diabetes complications.
文章引用:朱歆童, 阳路霜, 李晓庆, 魏丑婵, 孟佳璇, 陈庆红, 王圆, 先远洋, 王雨冰, 李继斌, 殷佳伟. 糖尿病慢性并发症与不良结局关联的研究进展[J]. 食品与营养科学, 2026, 15(2): 175-184. https://doi.org/10.12677/hjfns.2026.152020

参考文献

[1] Cuadros, D.F., Li, J., Musuka, G. and Awad, S.F. (2021) Spatial Epidemiology of Diabetes: Methods and Insights. World Journal of Diabetes, 12, 1042-1056. [Google Scholar] [CrossRef] [PubMed]
[2] Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B.B., et al. (2022) IDF Diabetes Atlas: Global, Regional and Country-Level Diabetes Prevalence Estimates for 2021 and Projections for 2045. Diabetes Research and Clinical Practice, 183, Article ID: 109119. [Google Scholar] [CrossRef] [PubMed]
[3] Baena-Díez, J.M., Peñafiel, J., Subirana, I., Ramos, R., Elosua, R., Marín-Ibañez, A., et al. (2016) Risk of Cause-Specific Death in Individuals with Diabetes: A Competing Risks Analysis. Diabetes Care, 39, 1987-1995. [Google Scholar] [CrossRef] [PubMed]
[4] Benjamin, E.J., Virani, S.S., Callaway, C.W., et al. (2018) Heart Disease and Stroke Statistics-2018 Update: A Report from the American Heart Association. Circulation, 137, e67-e492.
[5] World Health Organization (2024) Diabetes.
[6] International Diabetes Federation (2021) IDF Diabetes Atlas, 10th Edition.
[7] 中华医学会糖尿病学分会慢性并发症调查组. 1991-2000年全国住院糖尿病患者慢性并发症及相关大血管病变回顾性分析[J]. 中国医学科学院学报, 2002, 24(5): 447-451.
[8] An, Y., Zhang, P., Wang, J., Gong, Q., Gregg, E.W., Yang, W., et al. (2015) Cardiovascular and All-Cause Mortality over a 23-Year Period among Chinese with Newly Diagnosed Diabetes in the Da Qing IGT and Diabetes Study. Diabetes Care, 38, 1365-1371. [Google Scholar] [CrossRef] [PubMed]
[9] Litwak, L., Goh, S., Hussein, Z., Malek, R., Prusty, V. and Khamseh, M.E. (2013) Prevalence of Diabetes Complications in People with Type 2 Diabetes Mellitus and Its Association with Baseline Characteristics in the Multinational A1chieve Study. Diabetology & Metabolic Syndrome, 5, Article No. 57. [Google Scholar] [CrossRef] [PubMed]
[10] Cai, M., Xie, Y., Bowe, B., Gibson, A.K., Zayed, M.A., Li, T., et al. (2021) Temporal Trends in Incidence Rates of Lower Extremity Amputation and Associated Risk Factors among Patients Using Veterans Health Administration Services from 2008 to 2018. JAMA Network Open, 4, e2033953. [Google Scholar] [CrossRef] [PubMed]
[11] Park, J.H., Ha, K.H., Kim, B.Y., Lee, J.H. and Kim, D.J. (2021) Trends in Cardiovascular Complications and Mortality among Patients with Diabetes in South Korea. Diabetes & Metabolism Journal, 45, 120-124. [Google Scholar] [CrossRef] [PubMed]
[12] Einarson, T.R., Acs, A., Ludwig, C. and Panton, U.H. (2018) Prevalence of Cardiovascular Disease in Type 2 Diabetes: A Systematic Literature Review of Scientific Evidence from across the World in 2007-2017. Cardiovascular Diabetology, 17, Article No. 83. [Google Scholar] [CrossRef] [PubMed]
[13] Centers for Disease Control and Prevention (2020) United States Diabetes Surveillance System.
[14] Gesualdo, L., Fiorentino, M., Conserva, F. and Pontrelli, P. (2023) Should We Enlarge the Indication for Kidney Biopsy in Patients with Diabetes? The Pro Part. Clinical Kidney Journal, 17, sfad266. [Google Scholar] [CrossRef] [PubMed]
[15] Coward, R. and Fornoni, A. (2015) Insulin Signaling: Implications for Podocyte Biology in Diabetic Kidney Disease. Current Opinion in Nephrology and Hypertension, 24, 104-110. [Google Scholar] [CrossRef] [PubMed]
[16] Jin, Q., Liu, T., Qiao, Y., Liu, D., Yang, L., Mao, H., et al. (2023) Oxidative Stress and Inflammation in Diabetic Nephropathy: Role of Polyphenols. Frontiers in Immunology, 14, Article 1185317. [Google Scholar] [CrossRef] [PubMed]
[17] Piwkowska, A., Rogacka, D., Kasztan, M., Angielski, S. and Jankowski, M. (2013) Insulin Increases Glomerular Filtration Barrier Permeability through Dimerization of Protein Kinase G Type Iα Subunits. Biochimica et Biophysica Acta (BBA)—Molecular Basis of Disease, 1832, 791-804. [Google Scholar] [CrossRef] [PubMed]
[18] García-Carro, C., Vergara, A., Bermejo, S., Azancot, M.A., Sellarés, J. and Soler, M.J. (2021) A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management. Frontiers in Medicine, 8, Article 655871. [Google Scholar] [CrossRef] [PubMed]
[19] 时立新. 糖尿病神经病变的机制与药物治疗[J]. 中华糖尿病杂志, 2021, 13(4): 446-448.
[20] 邹大进, 陈月. 糖尿病微血管并发症的发病机制及治疗[J]. 中华糖尿病杂志, 2005, 13(5): 393-395.
[21] Callaghan, B.C., Gallagher, G., Fridman, V. and Feldman, E.L. (2020) Diabetic Neuropathy: What Does the Future Hold? Diabetologia, 63, 891-897. [Google Scholar] [CrossRef] [PubMed]
[22] Eid, S., Sas, K.M., Abcouwer, S.F., Feldman, E.L., Gardner, T.W., Pennathur, S., et al. (2019) New Insights into the Mechanisms of Diabetic Complications: Role of Lipids and Lipid Metabolism. Diabetologia, 62, 1539-1549. [Google Scholar] [CrossRef] [PubMed]
[23] Wong, T.Y., Cheung, C.M.G., Larsen, M., Sharma, S. and Simó, R. (2016) Diabetic Retinopathy. Nature Reviews Disease Primers, 2, Article No. 16012. [Google Scholar] [CrossRef] [PubMed]
[24] Li, Y., Mitchell, W., Elze, T. and Zebardast, N. (2021) Association between Diabetes, Diabetic Retinopathy, and Glaucoma. Current Diabetes Reports, 21, Article No. 38. [Google Scholar] [CrossRef] [PubMed]
[25] Fowler, M.J. (2011) Microvascular and Macrovascular Complications of Diabetes. Clinical Diabetes, 29, 116-122. [Google Scholar] [CrossRef
[26] 中国医疗保健国际交流促进会糖尿病足病分会, 国际血管联盟中国分部糖尿病足病专家委员会. 中国糖尿病足诊治指南[J]. 中国临床医生杂志, 2020, 48(1): 19-27.
[27] 李孟英. 糖尿病并发症的发病机制及药物治疗研究进展[J]. 中国城乡企业卫生, 2024, 39(5): 28-30.
[28] 王中群. 重视糖尿病大血管并发症的发病、机制、评估与防治研究[J]. 中南医学科学杂志, 2022, 50(1): 1-6.
[29] Harding, J.L., Pavkov, M.E., Magliano, D.J., Shaw, J.E. and Gregg, E.W. (2018) Global Trends in Diabetes Complications: A Review of Current Evidence. Diabetologia, 62, 3-16. [Google Scholar] [CrossRef] [PubMed]
[30] Park, J.H., Ha, K.H., Kim, B.Y., Lee, J.H. and Kim, D.J. (2021) Trends in Cardiovascular Complications and Mortality among Patients with Diabetes in South Korea. Diabetes & Metabolism Journal, 45, 283. [Google Scholar] [CrossRef] [PubMed]
[31] Alegre-Díaz, J., Herrington, W., López-Cervantes, M., Gnatiuc, L., Ramirez, R., Hill, M., et al. (2016) Diabetes and Cause-Specific Mortality in Mexico City. New England Journal of Medicine, 375, 1961-1971. [Google Scholar] [CrossRef] [PubMed]
[32] Di Angelantonio, E., Kaptoge, S., Wormser, D., Willeit, P., Butterworth, A.S., Bansal, N., et al. (2015) Association of Cardiometabolic Multimorbidity with Mortality. JAMA, 314, 52-60. [Google Scholar] [CrossRef] [PubMed]
[33] Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C.P. (2013) The Global Prevalence of Dementia: A Systematic Review and Metaanalysis. Alzheimers & Dementia, 9, 63-75.e2. [Google Scholar] [CrossRef] [PubMed]
[34] Long, S., Benoist, C. and Weidner, W. (2023) World Alzheimer Report 2023: Reducing Dementia Risk: Never Too Early, Never Too Late. Alzheimer’s Disease International.
[35] Wimo, A., Guerchet, M., Ali, G., Wu, Y., Prina, A.M., Winblad, B., et al. (2016) The Worldwide Costs of Dementia 2015 and Comparisons with 2010. Alzheimers & Dementia, 13, 1-7. [Google Scholar] [CrossRef] [PubMed]
[36] Alzheimer’s Association (2014) 2014 Alzheimer’s Disease Facts and Figures. Alzheimers & Dementia, 10, e47-e92. [Google Scholar] [CrossRef] [PubMed]
[37] Snyder, H.M., Corriveau, R.A., Craft, S., Faber, J.E., Greenberg, S.M., Knopman, D., et al. (2014) Vascular Contributions to Cognitive Impairment and Dementia Including Alzheimer’s Disease. Alzheimers & Dementia, 11, 710-717. [Google Scholar] [CrossRef] [PubMed]
[38] Small, S.A., Perera, G.M., DeLapaz, R., Mayeux, R. and Stern, Y. (1999) Differential Regional Dysfunction of the Hippocampal Formation among Elderly with Memory Decline and Alzheimer’s Disease. Annals of Neurology, 45, 466-472. [Google Scholar] [CrossRef] [PubMed]
[39] Watson, G.S., Peskind, E.R., Asthana, S., Purganan, K., Wait, C., Chapman, D., et al. (2003) Insulin Increases CSF Aβ42 Levels in Normal Older Adults. Neurology, 60, 1899-1903. [Google Scholar] [CrossRef] [PubMed]
[40] Zlokovic, B.V., Gottesman, R.F., Bernstein, K.E., Seshadri, S., McKee, A., Snyder, H., et al. (2020) Vascular Contributions to Cognitive Impairment and Dementia (VCID): A Report from the 2018 National Heart, Lung, and Blood Institute and National Institute of Neurological Disorders and Stroke Workshop. Alzheimers & Dementia, 16, 1714-1733. [Google Scholar] [CrossRef] [PubMed]
[41] Feinkohl, I., Aung, P.P., Keller, M., Robertson, C.M., Morling, J.R., McLachlan, S., et al. (2014) Severe Hypoglycemia and Cognitive Decline in Older People with Type 2 Diabetes: The Edinburgh Type 2 Diabetes Study. Diabetes Care, 37, 507-515. [Google Scholar] [CrossRef] [PubMed]
[42] Jacobson, A.M., Musen, G., Ryan, C.M., et al. (2007) Long-Term Effect of Diabetes and Its Treatment on Cognitive Function. The New England Journal of Medicine, 356, 1842-1852.
[43] Wu, M., Mei, F., Hu, K., Feng, L., Wang, Z., Gao, Q., et al. (2022) Diabetic Retinopathy and Cognitive Dysfunction: A Systematic Review and Meta-Analysis. Acta Diabetologica, 59, 443-459. [Google Scholar] [CrossRef] [PubMed]
[44] Chan, R.N.F., Tang, Z., Chan, V.T.T., Chan, R.N.C., Cheng, E.T.W., Ng, N.C.Y., et al. (2022) The Cross-Sectional and Longitudinal Relationship of Diabetic Retinopathy to Cognitive Impairment: A Systematic Review and Meta-Analysis. Eye, 37, 220-227. [Google Scholar] [CrossRef] [PubMed]
[45] Duan, L., Xiao, R., Liu, S., Shi, Y. and Feng, Y. (2024) Causality between Cognitive Performance and Cardiovascular Disease: A Bidirectional Mendelian Randomization Study. Gene, 891, Article ID: 147822. [Google Scholar] [CrossRef] [PubMed]
[46] Wing, R.R., Bolin, P., Brancati, F.L., et al. (2013) Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. New England Journal of Medicine, 369, 145-154. [Google Scholar] [CrossRef] [PubMed]
[47] Gæde, P., Vedel, P., Parving, H. and Pedersen, O. (1999) Intensified Multifactorial Intervention in Patients with Type 2 Diabetes Mellitus and Microalbuminuria: The Steno Type 2 Randomised Study. The Lancet, 353, 617-622. [Google Scholar] [CrossRef] [PubMed]
[48] ElSayed, N.A., Aleppo, G., Aroda, V.R., Bannuru, R.R., Brown, F.M., Bruemmer, D., et al. (2022) 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes—2023. Diabetes Care, 46, S128-S139. [Google Scholar] [CrossRef] [PubMed]
[49] Harrington, D. and Henson, J. (2021) Physical Activity and Exercise in the Management of Type 2 Diabetes: Where to Start? Practical Diabetes, 38, 35-40. [Google Scholar] [CrossRef
[50] UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33). Lancet, 352, 837-853. [Google Scholar] [CrossRef
[51] Nathan, D.M., Genuth, S., Lachin, J., et al. (1993) The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. The New England Journal of Medicine, 329, 977-986.
[52] Patel, A., Macmahon, S., Chalmers, J., et al. (2008) Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. The New England Journal of Medicine, 358, 2560-2572.
[53] Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P.D., et al. (2009) Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. New England Journal of Medicine, 360, 129-139. [Google Scholar] [CrossRef] [PubMed]
[54] Gerstein, H.C., Miller, M.E., Byington, R.P., et al. (2008) Effects of Intensive Glucose Lowering in Type 2 Diabetes. The New England Journal of Medicine, 358, 2545-2559.
[55] Zoungas, S., Arima, H., Gerstein, H.C., Holman, R.R., Woodward, M., Reaven, P., et al. (2017) Effects of Intensive Glucose Control on Microvascular Outcomes in Patients with Type 2 Diabetes: A Meta-Analysis of Individual Participant Data from Randomised Controlled Trials. The Lancet Diabetes & Endocrinology, 5, 431-437. [Google Scholar] [CrossRef] [PubMed]
[56] Hemmingsen, B., Lund, S.S., Gluud, C., Vaag, A., Almdal, T., Hemmingsen, C., et al. (2011) Intensive Glycaemic Control for Patients with Type 2 Diabetes: Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomised Clinical Trials. BMJ, 343, d6898. [Google Scholar] [CrossRef] [PubMed]
[57] UK Prospective Diabetes Study Group (1998) Tight Blood Pressure Control and Risk of Macrovascular and Microvascular Complications in Type 2 Diabetes: UKPDS 38. BMJ, 317, 703-713. [Google Scholar] [CrossRef
[58] Hansson, L., Zanchetti, A., Carruthers, S.G., Dahlöf, B., Elmfeldt, D., Julius, S., et al. (1998) Effects of Intensive Blood-Pressure Lowering and Low-Dose Aspirin in Patients with Hypertension: Principal Results of the Hypertension Optimal Treatment (HOT) Randomised Trial. The Lancet, 351, 1755-1762. [Google Scholar] [CrossRef] [PubMed]
[59] Stratton, I.M., Cull, C.A., Adler, A.I., Matthews, D.R., Neil, H.A.W. and Holman, R.R. (2006) Additive Effects of Glycaemia and Blood Pressure Exposure on Risk of Complications in Type 2 Diabetes: A Prospective Observational Study (UKPDS 75). Diabetologia, 49, 1761-1769. [Google Scholar] [CrossRef] [PubMed]
[60] Kearney, P.M., Blackwell, L., Collins, R., et al. (2008) Efficacy of Cholesterol-Lowering Therapy in 18 686 People with Diabetes in 14 Randomised Trials of Statins: A Meta-Analysis. The Lancet, 371, 117-125. [Google Scholar] [CrossRef] [PubMed]
[61] Palmer, B.F. and Clegg, D.J. (2021) Euglycemic Ketoacidosis as a Complication of SGLT2 Inhibitor Therapy. Clinical Journal of the American Society of Nephrology, 16, 1284-1291. [Google Scholar] [CrossRef] [PubMed]
[62] Vallon, V. and Verma, S. (2021) Effects of SGLT2 Inhibitors on Kidney and Cardiovascular Function. Annual Review of Physiology, 83, 503-528. [Google Scholar] [CrossRef] [PubMed]
[63] Wiviott, S.D., Raz, I., Bonaca, M.P., Mosenzon, O., Kato, E.T., Cahn, A., et al. (2019) Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. New England Journal of Medicine, 380, 347-357. [Google Scholar] [CrossRef] [PubMed]
[64] Perkovic, V., Jardine, M.J., Neal, B., Bompoint, S., Heerspink, H.J.L., Charytan, D.M., et al. (2019) Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. New England Journal of Medicine, 380, 2295-2306. [Google Scholar] [CrossRef] [PubMed]
[65] Savarese, G., Sattar, N., Januzzi, J., Verma, S., Lund, L.H., Fitchett, D., et al. (2019) Empagliflozin Is Associated with a Lower Risk of Post-Acute Heart Failure Rehospitalization and Mortality. Circulation, 139, 1458-1460. [Google Scholar] [CrossRef] [PubMed]
[66] Verma, S., Mazer, C.D., Al-Omran, M., Inzucchi, S.E., Fitchett, D., Hehnke, U., et al. (2018) Cardiovascular Outcomes and Safety of Empagliflozin in Patients with Type 2 Diabetes Mellitus and Peripheral Artery Disease: A Sub-Analysis of EMPA-REG Outcome. Circulation, 137, 405-407. [Google Scholar] [CrossRef] [PubMed]
[67] 潘慧敏, 王钰博, 单慧亭, 等. SGLT-2抑制剂治疗2型糖尿病的快速卫生技术评估[J]. 中国药房, 2025, 36(23): 2978-2984.
[68] Perkovic, V., Tuttle, K.R., Rossing, P., Mahaffey, K.W., Mann, J.F.E., Bakris, G., et al. (2024) Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. New England Journal of Medicine, 391, 109-121. [Google Scholar] [CrossRef] [PubMed]
[69] Kosiborod, M.N., Deanfield, J., Pratley, R., Borlaug, B.A., Butler, J., Davies, M.J., et al. (2024) Semaglutide versus Placebo in Patients with Heart Failure and Mildly Reduced or Preserved Ejection Fraction: A Pooled Analysis of the SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM Randomised Trials. The Lancet, 404, 949-961. [Google Scholar] [CrossRef] [PubMed]
[70] McGuire, D.K., Marx, N., Mulvagh, S.L., Deanfield, J.E., Inzucchi, S.E., Pop-Busui, R., et al. (2025) Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes. New England Journal of Medicine, 392, 2001-2012. [Google Scholar] [CrossRef] [PubMed]
[71] Gonzalez-Rellan, M.J. and Drucker, D.J. (2025) The Expanding Benefits of GLP-1 Medicines. Cell Reports Medicine, 6, Article ID: 102214. [Google Scholar] [CrossRef] [PubMed]
[72] Pandey, A.K., Bhatt, D.L., Cosentino, F., Marx, N., Rotstein, O., Pitt, B., et al. (2022) Non-Steroidal Mineralocorticoid Receptor Antagonists in Cardiorenal Disease. European Heart Journal, 43, 2931-2945. [Google Scholar] [CrossRef] [PubMed]
[73] Bakris, G.L., Agarwal, R., Anker, S.D., Pitt, B., Ruilope, L.M., Nowack, C., et al. (2019) Design and Baseline Characteristics of the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease Trial. American Journal of Nephrology, 50, 333-344. [Google Scholar] [CrossRef] [PubMed]
[74] Ruilope, L.M., Agarwal, R., Anker, S.D., Bakris, G.L., Filippatos, G., Nowack, C., et al. (2019) Design and Baseline Characteristics of the Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease Trial. American Journal of Nephrology, 50, 345-356. [Google Scholar] [CrossRef] [PubMed]
[75] Bakris, G.L., Agarwal, R., Anker, S.D., Pitt, B., Ruilope, L.M., Rossing, P., et al. (2020) Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. New England Journal of Medicine, 383, 2219-2229. [Google Scholar] [CrossRef] [PubMed]
[76] Meir, J., Huang, L., Mahmood, S., Whiteson, H., Cohen, S. and Aronow, W.S. (2023) The Vascular Complications of Diabetes: A Review of Their Management, Pathogenesis, and Prevention. Expert Review of Endocrinology & Metabolism, 19, 11-20. [Google Scholar] [CrossRef] [PubMed]
[77] Marshall, S.M. and Flyvbjerg, A. (2006) Prevention and Early Detection of Vascular Complications of Diabetes. BMJ, 333, 475-480. [Google Scholar] [CrossRef] [PubMed]