二甲双胍和食物纤维在糖耐量低减人群向2型糖尿病发展中的干预作用  

Prevention of type 2 diabetes in the population with impaired glucose tolerance by metformin and diet fibre

作　　者：陆菊明[1] 潘长玉[1] 田慧[1] 李春霖[1] 杨国庆[1] 张效良[2] 李溪雅[2] 成筱鹏[3] 许志秀[3] 蔡爱军[1] 樊爱平 李永昌 

机构地区：[1]解放军总医院内分泌科,北京100853 [2]解放军总医院营养科,北京100853 [3]北京理工大学校医院 [4]北京理工大学校医院总后第二门诊部 [5]北京理工大学校医院总后营房部门诊部

出　　处：《中国糖尿病杂志》2002年第6期340-343,共4页Chinese Journal of Diabetes

基　　金：军队九五科研基金资助项目 (0 1Z0 3 3 )

摘　　要：目的　观察二甲双胍和食物纤维预防糖耐量低减 (IGT)人群进展为 2型糖尿病 (DM)的作用。　方法　以口服 75 g葡萄糖耐量试验 (OGTT)确诊 (WHO标准 )的 IGT2 93例中男 2 16例 ,女 77例。入选者年龄 35岁以上 ,体重指数 (BMI)在 19kg/ m2以上。随机分为对照组 72例 ,教育组 5 7例 ,食物纤维组 84例 ,二甲双胍组 80例。对照组进行一般的健康教育 ;教育组进行饮食指导 ,每半年1次 ;食物纤维组除健康教育外 ,每日口服食物纤维 12 g;二甲双胍组每日口服二甲双胍 0 .75 g,分 3次餐后口服。对四组参试者每半年作 1次 OGTT,同时测身高、体重、BMI、12 h尿白蛋白 ,复查日当天不服干预药物或食物纤维。共观察 3年。若 2次 OGTT或最后 1次复查结果为 DM,则判断为已发展为 DM。　结果　 2 93例 IGT在观察中有 2 3例 (7.8% )退出。空腹血糖 (FBS)和服糖后 1h血糖 (1hPBS)在对照组、教育组和食物纤维组均较治疗前略有升高 ,但在二甲双胍治疗组均有下降。四组间FBS比较 F=8.118,P<0 .0 1,四组间 1h PBS比较 F=3.6 97,P=0 .0 12。观察期末对照组 16例 (2 5 .0 % )、教育组 11例 (2 1.6 % )、食物纤维组 13例 (16 .3% )、二甲双胍组 7例 (9.3% )转化为 DM,二甲双胍组在治疗后 DM转化率明显低于对照组 (χ2 =6 .318,P<0 .Objective To evaluate the efficacy of metformin and diet fibre intervention in preventing the conversion of impaired glucose tolerance (IGT) to type 2 diabetes mellitus.Methods The recruited 293 IGT subjects were diagnosed by 75 g OGTT (WHO, 1985), with their age more than 35 years and BMI more than 19 kg/m 2. They were divided into 4 groups, i.e. control (C) (72 cases), education (E) (57 cases), diet fibre (DF) (84 cases) and metformin (M) (80 cases) groups. The subjects of group E were given healthy diet education. The subjects of group DF were treated with diet fibre 12g daily, and group M were given metformin 0.75 g daily. 75 g OGTT was done every 6 months. They were followed 3 years. The primary end point was the development of diabetes based on 2 hour plasma glucose after 75 g glucose load. Results The IGT subjects consisted of 216 males and 77 females. 23 subjects (7.8%) were discontinued prematurely. At the end of the study, the fasting blood sugar (FBS) and post OGTT 1 hour glucose levels were slightly higher in group C, E, DF than baseline data, while both above glucose levels were significantly lower than baseline in group M( F=8.118, P<0.001, F=3.697, P= 0.012). The cumulative cases with conversion to diabetes were 16 (25.0%) in group C, 11(21.6%) in group E, 13(16.3%) in group DF, and 7( 9.33% ) in group M. Using the Chi square test the conversion rate of diabetes was significantly lower in group M than group C. The diabetes conversion rate was positively related to the age and FBS ( P <0.05) and was negatively related to the intervention methods ( P =0.013) using mono factor statistical analysis. And the diabetes conversion rate was positively related to the FBS( P = 0.03 ), and was negatively to the intervention methods ( P =0.034) using multi regression analysis. Conclusion Metformin is effective in delaying the conversion of IGT to type 2 diabetes mellitus. The diet fibre may also be effective in IGT intervention.

关 键 词：糖耐量低减 2型糖尿病 二甲双胍 食物纤维 治疗 

分 类 号：R587.1[医药卫生—内分泌]