제2형 당뇨병 환자에서 비만과 미세혈관 합병증 발생의 연관성: KNHIS 2009-2012
The Relationship between Obesity and Microvascular Complications in Type 2 Diabetes Patients: KNHIS Data from 2009-2012
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목적: 한국인 제2형 당뇨병환자에서 비만이 대표적인 만성 미세혈관 합병증인 심한 당뇨망막병증과 만성 신부전의 발생 위험인자인지 알아보고자 하였다. 대상과 방법: 국민건강보험공단 데이터베이스를 활용하여 2009년 1월부터 2012년 12월까지 전체 건강검진 수검자 중 제2형 당뇨병을 진단받은 30세 이상 성인 2,524,431명에 대하여 후향적 공단 자료 분석을 시행하여 제2형 당뇨병 환자에서 실명 위험 당뇨망막병증및 말기 신부전의 발생과 비만과 연관된 인자들 중 체질량지수와 허리둘레의 연관성을 분석하였다. 결과: 다변량 콕스 회귀분석을 사용하여 분석한 결과, 실명 위험 당뇨망막병증(vision threatening diabetic retinopathy)과 말기 신부전을 포함하는 미세혈관합병증의 발생 위험인자를 고려하였을 때, 체질량지수와 미세혈관합병증은 역선형 관계를 보이지만, 허리둘레가 클수록 미세혈관합병증의 발생 위험도가 증가하는 통계적으로 유의미한 연관성을 보였다(incidence rate ratio, 1.049/1.087/1.234; 95% confidence interval, 1.021-1.078/1.05-1.125/1.182-1.289). 결론: 제2형 당뇨병 환자에서 허리둘레가 클수록 미세혈관 합병증 발생 위험도가 증가되는 연관성을 확인할 수 있었다. 제2형 당뇨병환자에서 만성 미세혈관 합병증 발생 위험 평가를 위하여 현재 비만 척도로 사용 중인 체질량지수와 더불어 허리 둘레가 함께 사용되어야 할 것으로 사료된다.
Abstract
Purpose: To observe if obesity is a representative risk factor for vision-threatening proliferative diabetes retinopathy and endstage renal disease, which are major chronic microvascular complications in Korean Type 2 diabetes patients. Methods: A retrospective data analysis was conducted on 2,524,431 adults over the age of 30 years diagnosed with type 2 diabetesusing the Korean National Health Insurance Service-Health Screening database from January 2009 to December 2012. The association of body mass index (BMI) and waist circumference with the occurrence of sight-threatening diabetic retinopathyand end-stage renal disease in type 2 diabetes mellitus patients were analyzed. Results: Multivariable Cox regression analysis was carried out on the potential risk factors related to microvascular complications,including vision-threatening diabetic retinopathy and end-stage renal disease. BMI and microvascular complicationsshowed a reverse linear relationship, but a larger waist circumference was associated with a greater risk of microvascular complications(incidence rate ratio [IRR] = 1.049, 95% confidence interval [CI] = 1.021-1.078; IRR = 1.087, 95% CI = 1.05-1.125, andIRR = 1.234, 95% CI = 1.182-1.289) after adjusting other risk factors. Conclusions: In our study, the results showed that type 2 diabetic patients with a larger waist circumference were at greater riskfor microvascular complications. Thus, in addition to the BMI, the waist circumference should be used as the obesity parameterin microvascular complication risk assessment among type 2 diabetic patients.
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