糖尿病前期人群综合强化干预两年后的转归及影响因素  

Outcome and influencing factors of integrated intensive intervention in participants with impaired glucose regulation for two years

作　　者：卢艳慧[1] 陆菊明[2] 王淑玉[3] 李春霖[1] 刘力生[3] 郑润平[3] 田慧[1] 王先令[2] 杨丽娟[2] 张育青[2] 潘长玉[2] 

机构地区：[1]解放军总医院老年内分泌科,北京100853 [2]解放军总医院内分泌科,北京100853 [3]北京高血压联盟研究所

出　　处：《中华内分泌代谢杂志》2009年第1期30-33,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：首都医学发展科研基金北京医学卫生科技联合攻关项目（2002-1009）

摘　　要：目的采用2003年美国糖尿病学会（ADA）标准分析综合强化干预2年后糖尿病前期人群的转归及影响因素。方法将北京地区中老年人群流行病学调查筛查出的连续2年均为糖尿病前期的患者，随机分为常规治疗组（对照组）和综合强化治疗组（强化组）。对照组仅给予生活方式指导，强化组在生活方式干预同时分别给予二甲双胍或阿卡波糖，并且建议根据病情选用降压及调脂药物，服用阿司匹林。随访2年，分析转归及影响因素。结果2年后综合强化干预组的血糖、血压、体重指数、甘油三酯达标率显著高于对照组（P〈0．05）。强化组无1例进展为糖尿病，而对照组共8例（9．3％）进展为糖尿病；强化组逆转为正常糖耐量（NGT）的比例稍高于对照组（29．5％vs22．1％，P〉0．05）。Logistic逐步回归分析，发现腰围及收缩压的增加与糖尿病的发生呈独立正相关关系，而胰岛功能的改善与糖尿病的发生呈独立负相关关系。结论综合强化干预可显著降低糖尿病前期人群的糖尿病发生率，增加NGT的逆转率。腰围及收缩压的增加、胰岛β细胞功能的衰退是糖尿病前期人群进展为糖尿病的重要影响因素。Objective To investigate the outcome and related risk factors of integrated intensive intervention in participants with impaired glucose regulation （IGR） after two years by the criteria of American Diabetes Association 2003. Methods The subjects who remained to be IGR at the end of first year following 75 g oral glucose tolerance test were randomly assigned to either a routine care control group or to an intensive integrated intervention group. The control group received general dietary and exercise advice at baseline and was followed up. In addition to dietary control and exercise advice, metformin or acarbose were administrated in the intervention group. The latter group was also advised to take antihypertensive agents, lipid-regulating agents if necessary, as well as aspirin. Results The proportion of patients who fulfilled the assigned goals of blood glucose, blood pressure, body mass index or triglycerides was significantly higher in the intensive group than those in the control group. None in the intensive group developed overt diabetes mellitus, while 8 （9.3%） in the control group did. The proportion of patients who reverted to normal glucose tolerance （NGT） was slightly higher in the intensive group than in the control group （29.5% vs 22.1% , P〉0.05 ）. Logistic analysis showed that increase of waist circumference and systolic blood pressure was positively while the improvement of islet β-cell function was negatively correlated with the development of diabetes mellitus. Conclusions The intensive integrated intervention could significantly decrease the conversion rate of IGR to diabetes mellitus, and increase the chance of reversion to NGT. The increase of waist circumference or systolic blood pressure, the deterioration of islet β-cell function were the influencing factors of the conversion of IGR to diabetes mellitus.

关 键 词：糖调节受损 综合强化干预 糖尿病 

分 类 号：R686[医药卫生—骨科学]