标准化代谢性疾病管理模式下不同体重新诊断2型糖尿病患者的血糖转归  

Glycemic control of newly-diagnosed type 2 diabetes with different baseline body mass index under the standardized metabolic disease management model

作　　者：黄婧婧 马宇航[1] 赖梦宇 杨嘉颖 魏小辉 张爱芳[1] 顾丽萍[1] 王育璠[1] 彭永德[1] Huang Jingjing;Ma Yuhang;Lai Mengyu;Yang Jiaying;Wei Xiaohui;Zhang Aifang;Gu Liping;Wang Yufan;Peng Yongde(Department of Endocrinology and Metabolism,Shanghai General Hospital,Shanghai Jiaotong University,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院内分泌代谢科,200080

出　　处：《中华内分泌代谢杂志》2019年第12期1025-1030,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然基金项目(81870610);上海市科委医学引导类科技项目(18411968800)。

摘　　要：目的探讨不同体重新诊断2型糖尿病患者在接受标准化代谢性疾病管理6个月后的血糖转归情况。方法(1)将163例新诊断2型糖尿病患者根据基线体重指数分为正常组(体重指数18.5~23.9 kg/m^2)、超重组(体重指数24.0~27.9 kg/m^2)和肥胖组(体重指数≥28 kg/m^2),比较3组患者基线糖脂代谢情况。(2)所有患者均接受标准化的代谢性疾病管理,比较治疗6个月后的血糖控制情况。(3)在肥胖和超重患者中,根据治疗6个月后是否减重≥5%分成2组,比较2组患者治疗前后的血糖控制情况。结果(1)基线时,与正常组相比,超重和肥胖组的胰岛素抵抗指数更高,高密度脂蛋白胆固醇更低。(2)经过6个月的治疗,在调整了基线HbA1C后,正常组、超重组、肥胖组的HbA1C水平及降幅无明显差异,HbA1C达标率(以HbA1C<7%为达标)分别为(77.78%对83.95%对80.43%,P>0.05)。(3)治疗6个月后,32.28%的超重和肥胖患者减重≥5%。在调整了基线HbA1C值后,减重≥5%组与增重或减重<5%组间的HbA1C值均得到满意控制[(6.27±1.38对6.43±0.66)%],但差异无统计学意义(P>0.05)。与增重或减重<5%组相比,减重≥5%组的HbA1C达标率更高(92.68%对77.91%,P<0.05)。结论随着体重指数的增加,新诊断2型糖尿病患者的胰岛素抵抗和脂代谢紊乱更严重。经过6个月标准化管理后,不同基线体重和体重变化患者的血糖均获得良好控制。此外,减重≥5%能提高超重和肥胖患者的HbA1C达标率。Objective To explore the glycemic control of newly-diagnosed type 2 diabetes with different levels of baseline body mass index(BMI)after 6 months treatment under the standardized metabolic disease management model.Methods(1)163 patients of newly-diagnosed type 2 diabetes were divided into normal weight(BMI 18.5-23.9 kg/m^2),overweight(BMI 24.0-27.9 kg/m^2),and obese(BMI≥28 kg/m^2)groups according to baseline BMI,the blood glucose and lipids levels were compared among 3 groups.(2)The blood glucose levels were compared among 3 groups after 6 months of standardized management.(3)The overweight and obese patients were divided into group weight loss≥5%and group weight loss<5%or weight gain in 6 months.The blood glucose levels were compared.Results(1)At baseline,overweight and obese groups had higher homeostasis model assessment for insulin resistance and lower high density lipoprotein-cholesterol compared with normal weight group.(2)After 6 months of treatment,HbA1C and HbA1C reduction showed no difference among 3 groups(normal,overweight and obese)after adjusted by baseline HbA1C.The rate of HbA1C<7%among 3 groups were 77.78%,83.95%,and 80.43%(P>0.05).(3)After 6 months of treatment,32.28%overweight and obese patients lost weight by≥5%,while HbA1Cand HbA1Creduction showed no difference between 2 groups(weight loss≥5%and weight gain or weight loss<5%)after adjusted by baseline HbA1C.Both groups achieved good glycemic control[(6.27±1.38 vs 6.43±0.66)%],but have no significantly(P>0.05).Group weight loss≥5%had better glucose control(92.68%vs 77.91%,P<0.05).Conclusions As BMI increased,insulin resistance and lipid disorders were more serious in newly-diagnosed type 2 diabetes.After 6 months of standardized metabolic management,newly-diagnosed type 2 diabetes with different baseline BMI and weight changes both achieved good glycemic control.In addition,patients losing weight equal to or more than 5%achieved higher attainment of HbA1C targets.

关 键 词：新诊断2型糖尿病 体重指数 糖化血红蛋白 体重变化 

分 类 号：R587[医药卫生—内分泌]