糖尿病作为一种慢性代谢性疾病，通常不会在患者身上独立存在，而常与其他诸多非健康状态或疾病并存，在这个“数病齐发”的过程中糖尿病往往扮演着“助攻手”的角色，今天就让我们展开一次大盘点，细数糖尿病都会给我们带来怎样的疾病风险……

糖尿病是白内障的危险因素^[1]，年龄与白内障密切相关，在老年人中白内障是最主要的致盲原因^[2]。

糖尿病患者的青光眼风险较非糖尿病更高^[3]。

干眼症是最常见的眼部疾病^[4]，糖尿病与干眼症的风险显著相关^[5]

糖尿病患者口腔疾病的患病率、病程和严重程度均较非糖尿病人群明显增加^[6]。牙周炎是糖尿病的常见伴发疾病之一，糖尿病是牙周炎的重要危险因素，糖尿病患者与非糖尿病人群相比，牙周炎的发生风险增加近3倍。

糖尿病肾脏病变、、是我国慢性肾脏病的主要原因^[7]。

糖尿病神经病变是糖尿病常见的慢性并发症之一，是一组具有多种临床表现的异质性疾病，病变可累及中枢神经和周围神经。

远端对称性多发性神经病变：是最常见的糖尿病周围神经病变，约占糖尿病神经病变的 75%，是糖尿病足溃疡的重要危险因素，也是跌倒及骨折的重要原因^[8]。

糖尿病患者的骨折风险明显超过非糖尿病人群^[9]。

老年糖尿病患者发生抑郁的风险高于非糖尿病的老年人^[10]。

糖尿病患者肿瘤风险增加，包括肝细胞癌、肝胆管癌、胰腺癌、乳腺癌、卵巢癌、子宫内膜癌和胃肠道恶性肿瘤等多种癌症^[11]。

心血管疾病：糖尿病病人比正常人更容易产生动脉粥样硬化，而且发展迅速，从而导致冠心病、脑血管意外等。在T1DM患者中冠心病（CHD）、心肌梗死、心力衰竭、房颤的患病率明显升高^[12]。

心脏自主神经病变：血糖变异性大的糖尿病患者更有可能出现心脏自主神经病变^[13]。

脑血管疾病：糖尿病是中风最重要的危险因素之一。单独患有2型糖尿病（T2DM）会使中风的风险增加1.5到4倍；T2DM和较高的HbA1c水平与任何缺血性中风，大动脉中风和小血管中风的风险较高相关^[14]。

糖尿病患者下肢动脉病变通常是指下肢动脉粥样硬化性病变（lower extremity atherosclerotic disease，LEAD）。中国DIALEAD研究显示，我国50岁以上T2DM中LEAD的总患病率为21.2%，且患病率随着年龄、糖尿病病程增加而升高^[15]。在患LEAD的T2DM患者中，心肌梗死、脑卒中、冠心病导致的死亡风险均增加^[16]。

糖尿病足是指糖尿病患者因下肢远端神经病变和血管病变导致的足部感染、溃疡，甚至深层组织破坏，是糖尿病严重的慢性并发症之一，严重者可以导致截肢和死亡。我国糖尿病足患者的总截肢率为19.03%^[17]。

感染：糖尿病与多种感染的风险增加有关，包括：皮肤和软组织感染、呼吸道感染、泌尿生殖道感染、血液感染、头颈部感染、胃肠道感染、骨感染等^[18]。

肝脏疾病：与非糖尿病患者相比，糖尿病患者肝脂肪变性的概率更高，与其内脏脂肪组织（VAT）面积相关^[19]；此外，非酒精性脂肪肝病（NAFLD）可以进展为晚期纤维化，尤其是在2型糖尿病患者中^[20]。

胆囊结石：与没有糖尿病的患者相比，患有2型糖尿病的患者发生胆囊结石的风险增加^[21]。

贫血：贫血是糖尿病成年患者中的中度公共卫生问题，性别、糖尿病持续时间、糖尿病并发症的存在和糖尿病合并症被确定为与贫血相关的因素。其中，贫血的发生在女性比男性糖尿病患者更多；糖尿病≥5年的患者比糖尿病病程为1-5年的患者更容易发生贫血；有合并症的糖尿病患者比没有合并症的糖尿病患者更容易贫血^[22]。  

甲状腺疾病：糖尿病患者的甲状腺疾病患病率是非糖尿病患者的2-3倍^[23]；特别是自身免疫性甲状腺炎^[24]。

电解质紊乱：糖尿病患者发生酮症酸中毒时，出现严重电解质紊乱，其血清钾、钠、磷、镁含量和有效渗透压明显升高^[25]。

痴呆：2型糖尿病轻度认知障碍患者较非糖尿病患者更易转化为痴呆，2型糖尿病是轻度认知障碍患者痴呆转化的独立危险因素[26]。

还有很多疾病都因糖尿病而导致患病率上升，或者因糖尿病而加重。所以我们在临床工作中必须注意糖尿病的防治。

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（来源：医学界内分泌频道，作者：朱益丽、于一江，单位：淮安市中医院）