空腹血糖水平对非胰岛素依赖型糖尿病发病的预测价值——638例非糖尿病人群六年前瞻性观察

为了解空腹血糖（ＦＢＧ）水平对非胰岛素依赖型糖尿病（ＮＩＤＤＭ）发病的预测价值，对１９８６年６３８例非糖尿病人群（糖耐量正常３４１例，糖耐量低减２９７例）于１９９２年进行血糖复查。结果发现，随着初访时ＦＢＧ水平增高，６年后ＮＩＤＤＭ发病率逐步增加。ＣＯＸ成比例风险模型分析，在调整了年龄、性别和体重指数的影响后，在糖耐量低减组ＦＢＧ仍与ＮＩＤＤＭ发病显著正相关（Ｐ＝０．０００１），ＦＢＧ均值为５．１９ｍｍｏｌ／Ｌ亚组与均值４．６１ｍｍｏｌ／Ｌ亚组相比，ＮＩＤＤＭ发病危险已有显著差异（ＲＲ２．１，９５％可信区间１．１９～３．７４，Ｐ＝０．０１）。ＦＢＧ均值为６．５０ｍｍｏｌ／Ｌ组，ＮＩＤＤＭ发病危险更高（ＲＲ２．９，９５％可信区间１．７９～４．５９，Ｐ＝０．０００１）。认为ＦＢＧ水平为ＮＩＤＤＭ发病的独立危险因素     

非胰岛素依赖型糖尿病和糖耐量低减患病情况研究

我们于１９９４年７月－１９９５年３月对湖北省部分地区２５岁及以上的９４５０名居民进行了非胰岛素依赖型糖尿病与糖耐量低减患病率的抽样调查。结果表明：ＮＩＤＤＭ患病率为２．６２％，ＩＧＴ患病率４．４８％，男女性的ＮＩＤＤＭ与ＩＧＴ患病率差异无显著性，城乡ＮＩＤＤＭ，ＩＧＴ患病率差异有显著性，ＮＩＤＤＭ和ＩＧＴ的患病率均随着年龄升高而升高。     

空腹血糖水平对非胰岛素依赖型糖尿病发病的预测价值：638例非糖…

为了解空腹血糖（ＦＢＧ）水平对非胰岛素依赖型糖尿病（ＮＩＤＤＭ）发病的预测价值，对１９８６年６３８例非糖尿病人群（糖耐量正常３４１例，糖耐量低减２９７例）于１９９２年进行血糖复发，结果发现，随着初访时ＦＢＧ水平增高。６年后ＮＩＤＤＭ发病率逐步增加，ＣＯＸ成比例风险模型分析，在调整了年龄，性别和体重指数的影响后，在糖耐量低减组ＦＢＧ仍与ＮＩＤＤＭ发病显著正相关（Ｐ＝０．０００１），ＦＢＧ均值为５．１     

陈旧性心肌梗塞患者糖代谢及相关因素的调查分析

追踪调查了２２４例陈旧性心肌梗塞患者的糖代谢状况，分析该人群糖耐量异常与冠心病发病危险因素的联系。２２４例中，符合ＮＩＤＤＭ诊断者５２例，符合ＩＧＴ诊断者５４例，计高血糖占４７．３％。与同期同社区３万普通人群成年糖尿病调查结果比较，分别是其５０－５９岁及≥６０岁同年龄组ＮＩＤＤＭ患病率的２．７及３．２倍，ＩＧＴ患病率的３．４及３．７倍。显示了心肌梗塞与糖代谢异常二者间的密切联系。     

NIDDM患者口服降糖药失效后的胰岛素使用问题

ＮＩＤＤＭ患者口服降糖药失效后的胰岛素使用问题ＣｏｃｋｒａｍＣ（向红丁译）在香港和中国大陆，９７％的糖尿病患者属于非胰岛素依赖型糖尿病（ＮＩＤＤＭ）。在香港，工龄阶段成人中糖尿病患病率为４．５％，而６０岁以上人群中糖尿病患病率超过１０％。对ＮＩＤＤＭ...     

非胰岛素依赖型糖尿病合并冠心病者的胰岛素抵抗

为了解非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人中胰岛素抵抗与冠心病的关系，对４０例ＮＩＤＤＭ合并冠心病的男病人与３６例未合并冠心病的ＮＩＤＤＭ男病人的血糖、胰岛素、胰岛素敏感性指数（ＩＳＩ）、血脂、载脂蛋白等进行比较，并对其与冠心病的关系进行多因素ｌｏｇｉｓｔｉｃ逐步回归分析，结果显示，ＮＩＤＤＭ病人中的ＩＳＩ与冠心病呈显著负相关（ＯＲ０．２３７，９５％可信区间０．０９０９～０．６１６７，Ｐ＝０．００３２），这种相关独立于年龄、肥胖、血压、血脂等心血管危险因素。提示胰岛素抵抗是非胰岛素依赖型糖尿病病人冠心病发病的独立危险因素。     

1996年全国糖尿病流行病学特点基线调查报告

根据ＷＨＯ１９８５年标准，采用自然人群、分层整群抽样方法，我们于１９９５￣１９９６年对全国１１省市２０￣７５岁４万人群进行糖尿病（ＤＭ）及糖耐量低减（ＩＧＴ）流行病学特点的基线情况调查，并对人群营养状况进行了深入细致的调查分析。结果显示目前我国ＤＭ及ＩＧＴ患病率分别为３．２１％和４．７６％，省会城市最高，中小城市次之，贫困农村最低。ＤＭ及ＩＧＴ患病率随年龄、体重指数及腰／臀比的增加而增高。     

糖尿病合并高血压对心,脑血管病变的影响

对１９９４例住院非胰岛素依赖型糖尿病（ＮＩＤＤＭ）合并高血压（ＨＴ）对心、脑血管病变的影响作回顾性研究。结果合并ＥＨ（８１５例，占４１．９２％）的病人中脑梗塞（２１７例，占１２．１９％），脑出血（９例，占０．４６％），冠心病（５７８例，占２９．７３％），心肌梗塞（１０３例，占５．３０％）的患病率显著高于正常血压ＮＩＤＤＭ组。多因素逐步回归分析显示高血压、肥胖和年龄的增加是ＮＩＤＤＭ患者并发心、脑血管病变的危险因素     

北京地区20682人群糖尿病筛查及1566人OGTT的研究

为积极开展对糖尿病的防治，我们在１９９４年北京地区年龄≥２５岁、城市农村各半的２０６８２人群进行标准馒头餐试验，以馒头餐后２小时血糖≥６．７ｍｍｏｌ／Ｌ者１５６６人施以ＯＧＴＴ、胰岛素、血脂、尿白蛋白及血压（ＢＰ）、ＥＣＧ检查。结果表明：北京地区糖尿病（ＤＭ）患病率为３．４４％，比１９８０年增高４．８倍，糖耐量减低（ＩＧＴ）患病率为３．２６％，北京近郊和远郊农村ＤＭ和ＩＧＴ患病率都明显高于城区（Ｐ＜０．００１）。ＢＭＩ≥２５和ＢＰ＞１８．７／１２．０ｋＰａ（１４０／９０ｍｍＨｇ）者ＤＭ和ＩＧＴ的患病率明显高于ＢＭＩ＜２５和ＢＰ≤１８．７／１２．０ｋＰａ者，患病率随年龄增加呈等倍级数递增。本次调查而诊断的ＤＭ组中，已并发冠心病者占２６．９６％，并发早期糖尿病肾病者占３２．８％。     

心肌梗塞存活人群冠心病发病危险因素与胰岛素抵抗的关联

心肌梗塞存活人群冠心病发病危险因素与胰岛素抵抗的关联姚央潘长玉陆菊明王淑玉近年来提出的胰岛素抵抗综合征的概念，深化了人们对糖耐量低减（ＩＧＴ）及非胰岛素依赖型糖尿病（ＮＩＤＤＭ）易发生冠心病的机理的认识。本文分析２２４例心肌梗塞后存活者合并不同数目冠...     

Impaired glucose tolerance and diabetes mellitus in Hindu Indian immigrants in Dar es Salaam.

The prevalence of Impaired Glucose Tolerance (IGT) and diabetes mellitus was studied in a migrant Hindu Indian community in Dar es Salaam, Tanzania. Using 1985 WHO criteria, 75 g oral glucose tolerance tests (OGTT) were performed on 1147 (583 men; 564 women) subjects aged 15 years and over. The age-standardized prevalence of IGT in men and women was 15.2 and 17.2%, and that of diabetes was 9.1% (6.5% known; 2.6% previously undiagnosed) and 9.0% (3.7% known; 5.3% previously undiagnosed), respectively. Diabetes was present in 12.9% of men and 12.8% of women aged 35 years and above. The overall age- and sex-standardized prevalence of IGT was 16.2% and of diabetes 9.1%. The major risk factors associated with diabetes in both men and women were age, family history of diabetes, and physical inactivity, and in women body mass index (BMI). Age and BMI contributed to the higher frequency of IGT in women as compared with men while in men, age was the only contributory factor. Despite overweight and obesity being more frequent in women than men, age-standardized prevalence rates of IGT and diabetes were similar between men and women. The decreased prevalence of diabetes in men and women performing moderate/heavy physical activity was independent of age and BMI.     

Noninsulin-dependent diabetes mellitus in black and white Americans

This report presents an overview of the prevalence, characteristics, morbidity, mortality, and risk factors for noninsulin-dependent diabetes (NIDDM) in Blacks and Whites in the United States. Data are drawn primarily from national surveys, but the report also includes the few clinical studies that have differentiated the two races. NIDDM constitutes 90-95% of all diabetes in the United States and is more prevalent in Black Americans than in Whites. Diabetes prevalence increases with age for both races and reaches 26% among Blacks aged 65-74 years compared with 18% among Whites. Rates of diabetes among persons aged 20-74 years are 30% higher in White women, 70% higher in Black men, and 100% higher in Black women, compared with White men. Approximately half of diabetes is undiagnosed in both races. White and Black diabetics are similar with regard to age, duration of diabetes, and diabetes therapies, although Blacks of both sexes are more obese than their White counterparts. Rates of vision loss, amputations, and renal disease are 1.5-4 times higher in Blacks than in Whites, although prevalence of hypertension is about equal in the two races. Blacks and Whites see the same physician specialists for their diabetes, but Whites have approximately 40% more visits to office-based physicians each year. Diabetes-specific mortality has declined significantly in the past decade and may now be lower in Black than in White diabetics. Risk factors for diabetes, including age, sex, obesity, and family history of diabetes, all operate within both race groups and probably interact with each other. The effect of gender and family history on rates of diabetes is similar in Blacks and Whites. Blacks have higher rates of diabetes at each obesity level, indicating that obesity alone cannot explain the differential in prevalence between the races. Impaired glucose tolerance (IGT), a strong risk factor for development of diabetes, increases with age in all race/sex groups except for Black women older than 54 years in whom rates of IGT, decline, possibly because of conversion of IGT to diabetes.     

Impact of poverty on the prevalence of diabetes and its complications in urban southern India.

AIM: The impact of poverty on the profile of diabetes and its complications was studied. METHODS: A comparative study of low income group (LIG) (family income Rs. < 30,000/annum (approx. 432 pounds sterling) and high income group (HIG) (family income Rs. greater-than-or-equal 60,000/annum (approx. pounds sterling) subjects of > or = 40 years was done in Madras, India. By screening 1748 LIG subjects (M/W 844/904) 301 diabetic subjects were identified and 218 underwent tests for diabetic complications. Population data available in 635 (M/W 309/326) HIG subjects from the survey were used for comparison of glucose tolerance profile. Complications were studied in 221 diabetic HIG subjects. RESULTS: Age-standardized prevalences of diabetes (12.6% vs. 25.5%; chi(2) = 56.9, P < 0.0001) and impaired glucose tolerance (IGT) (8.9% vs. 19.0%) were significantly lower (chi(2) = 57.7; P < 0.0001) in the LIG. Hypertension was more common in LIG (53.7% vs. 40.0% in HIG; chi(2) = 34.9; P < 0.0001). LIG subjects were more physically active; 73.8% did not go to school. Parameters significantly associated with diabetes were body mass index (BMI), age, higher income, waist--hip ratio and physical inactivity. Higher income, BMI and age were associated with IGT. Diabetic LIG subjects had a higher prevalence of cardiac disease, neuropathy and cataract and a lower prevalence of retinopathy than HIG subjects. The risk variables such as hyperglycaemia, dyslipidaemia, hypertension, smoking and alcohol consumption were more in the LIG group. CONCLUSIONS: The urban poor in the developing world has a lower prevalence of diabetes than the urban poor in developed societies. However, they have higher rates of complications of diabetes.     

Rising prevalence of NIDDM in an urban population in India

Summary A survey conducted in 1988–1989, in the city of Madras, South India, showed that the prevalence of diabetes mellitus in adults was 8.2 % and prevalence of impaired glucose tolerance (IGT) was 8.7 %. The present survey was another cross-sectional study conducted 5 years later in the same urban area to study the temporal changes in the prevalence of diabetes and IGT. The two sample populations surveyed were similar in age structure and socioeconomic factors. In the second survey in 1994–1995, a total of 2183 subjects, 1081 men and 1102 women, with a mean age of 40 ± 12 years were tested by an oral glucose tolerance test; fasting and 2-h post-glucose plasma glucose were measured. Anthropometric measurements, details of physical activity and clinical history of diabetes were recorded. Age-standardised prevalence of diabetes had increased to 11.6 % from 8.2 % in 1989 and IGT was 9.1 %, similar to 8.7 % in 1989. Multiple regression analysis showed age, waist : hip ratio, body mass index (BMI) and female sex were correlated to diabetes. Family history of diabetes showed interaction with age and BMI. Prevalence of IGT correlated to age, BMI and waist : hip ratio. This study highlights the rising trend in the prevalence of non-insulin-dependent diabetes (NIDDM) in urban Indians. The persistent high prevalence of IGT may also be a predictor of a further increase in NIDDM in the future. No significant differences in the anthropometric data were noted in this compared to the previous study. [Diabetologia (1997) 40: 232–237] Received: 24 April 1996 and in final revised form: 31 October 1996     

High prevalence of undiagnosed diabetes mellitus in Southern Germany: Target populations for efficient screening. The KORA survey 2000

AIMS/HYPOTHESIS: To estimate the prevalence of undiagnosed diabetes mellitus, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), and their relations with cardiovascular risk factors in the general population aged 55 to 74 years in Southern Germany. METHODS: Oral glucose tolerance tests were carried out in a random sample of 1353 subjects aged 55 to 74 years participating in the KORA (Cooperative Health Research in the Region of Augsburg) Survey 2000. Prevalences of glucose tolerance categories (1999 WHO criteria) were adjusted for sample probabilities. The numbers needed to screen (NNTS) to identify one person with undiagnosed diabetes were estimated from age-adjusted logistic regression models. RESULTS: Sample design-based prevalences of known and unknown diabetes, IGT, and IFG were 9.0%, 9.7%, 16.8%, 9.8% in men, and 7.9%, 6.9%, 16.0%, 4.5% in women, respectively. In both sexes, participants with undiagnosed diabetes had higher BMI, waist circumference, systolic blood pressure, triglycerides, uric acid, and lower HDL-cholesterol than normoglycaemic subjects. A combination of abdominal adiposity, hypertension, and parental diabetes in men resulted in a NNTS of 2.9 (95%CI: 2.0-4.6). In women, the combination of increased triglycerides, hypertension and parental diabetes history yielded a NNTS of 3.2 (95%CI: 2.2-5.1). CONCLUSION/INTERPRETATION: About 40% of the population aged 55 to 74 years in the Augsburg region have disturbed glucose tolerance or diabetes. Half of the total cases with diabetes are undiagnosed. Cardiovascular risk factors worsen among glucose tolerance categories, indicating the need for screening and prevention. Screening for undiagnosed diabetes could be most efficient in individuals with abdominal adiposity (men), hypertriglyceridaemia (women), hypertension, and parental diabetes history.     

Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population

The prevalence of ischemic heart disease (IHD) in older adults by glucose tolerance status was evaluated in 2,223 white men and women, aged 50-89 years, in the Rancho Bernardo cohort who were studied between 1984 and 1987. Impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) were classified according to World Health Organization criteria. End points of ischemic heart disease were defined by Rose Questionnaire and resting electrocardiogram (ECG) according to the Minnesota Code. IHD by electrocardiographic changes was classified as asymptomatic (without history of chest pain or overt IHD) or symptomatic (with history). IHD by all criteria combined was significantly more common in men and women with NIDDM, and in women with IGT, than in those with normal glucose tolerance. The prevalence of myocardial infarction, defined by major Q wave, Rose Questionnaire chest pain criteria, or personal history, was higher in persons with NIDDM than in persons without; the difference was highly significant in women (odds ratio, 2.08 [1.22, 3.56]; p = 0.009). Angina pectoris was not significantly related to NIDDM or IGT in either sex. Electrocardiographic evidence of asymptomatic IHD was significantly more prevalent in both men and women with NIDDM as compared with those with normal glucose tolerance (odds ratios, 1.75 [1.10, 2.81] for men and 1.80 [1.07, 3.01] for women; p less than 0.05). This significant association persisted after excluding persons on digitlis or diuretic therapy and, in women, was also independent of the effect of major known IHD risk factors. These population-based data are consistent with clinical reports suggesting an association of diabetes with silent myocardial infarction or ischemia. The presence of ischemic resting electrocardiographic abnormalities in the asymptomatic diabetic patient is likely to have prognostic and therapeutic implications.     

Clinical features in persons with a family history of diabetes compared to controls (The Second Generation Fredericia Study)

Objective. To compare clinical and biochemical features in non-diabetic persons with a family history of non-insulin dependent diabetes mellitus (NIDDM) to non-diabetic persons without a family history of diabetes.
Design. Cross-sectional study.
Setting. Population-based survey in Fredericia, Denmark.
Subjects. Seven hundred and forty subjects, the second generation of an earlier defined cohort was examined. The median age was 48 (range 26–65) years. Of the 740 subjects 696 were non-diabetic.
Interventions. The subjects had a clinical examination.
Main outcome measures . Known risk factors for development of diabetes and cardiovascular disease.
Results. More offspring of diabetic persons had NIDDM (χ²=6.36, P <0.05). Non-diabetic males with a family history of diabetes had a higher BMI, fasting blood glucose, and triglycerides compared to males without a family history of diabetes. Non-diabetic females with a family history of diabetes had a higher BMI, fasting blood glucose, HbA_1C, diastolic blood pressure, and lower HDL-cholesterol than female offspring of non-diabetics. In a multiple regression model we found that non-diabetic offspring of diabetic persons had higher fasting blood glucose and HbA_1C compared to offspring of non-diabetic persons when adjusted for the independent variables age, BMI, WHR, and sex.
Conclusion. Our results may indicate that the only inherited factors from NIDDM patients are plasma blood glucose, HbA_1C and increased BMI which may be an indication for later diabetes, whereas other cardiovascular risk factors may be inherited independently of diabetes but associated with BMI.     

Temporal changes in prevalence of type 2 diabetes and impaired glucose tolerance in urban southern India

The prevalence of type 2 diabetes and impaired glucose tolerance (IGT) is increasing in urban areas of developing countries, especially in India. This is a report of the temporal changes in the prevalence of diabetes and IGT in urban areas of Chennai (Madras), India, in adults aged > or =20 years, with an emphasis on identifying the risk factors responsible for the changes. Three urban diabetic surveys conducted in 1989, 1995 and 2000 were compared for the age-standardized prevalence, anthropometric, demographic and lifestyle characteristics of the glucose-intolerant groups. Multiple logistic regression analyses were used for the identification of risk variables associated with diabetes and IGT. The trend was statistically significant for diabetes (chi(2)=18.0, P<0.001) and for IGT (chi(2)=48.2, P<0.001). The period between 1989 and 1995 showed a 40% rise in the prevalence of diabetes and a further increase of 16.4% in the next 5 years. Age increased in each survey for both genders. Waist girth and waist:hip ratio were significantly higher in women, in the 2000 survey. There was no change in the mean body mass index with time in both genders. An increase in IGT was seen in year 2000, especially so in subjects aged <40 years. The prevalence of diabetes and IGT is increasing in India. Increasing age and positive family history showed associations with diabetes.     

Family history of diabetes identifies a group at increased risk for the metabolic consequences of obesity and physical inactivity in EPIC-Norfolk: a population-based study. The European Prospective Investigation into Cancer

OBJECTIVE: To investigate the interaction of a family history of diabetes with obesity and physical inactivity on diabetes prevalence in middle-aged and elderly men and women. DESIGN: A cross-sectional population-based study. SUBJECTS: 2,912 men and 3,561 women, aged 45-74y. MEASUREMENTS: Body mass index (BMI), HbA1C, self-administered questionnaire including questions on occupational physical activity and personal and family history of diabetes as part of the Norfolk arm of the European Prospective Investigation into Cancer (EPIC-Norfolk). RESULTS: The prevalence of diabetes increased in a dose-response relationship with increasing BMI. There was an interaction between family history and obesity on diabetes risk in subjects with a BMI of greater than 27.5kg/m2 (P= 0.049). Crude prevalence in individuals without a family history and BMI of 22.5-24.9 kg/m2 was 2.2% compared to 33.3% in those with a family history and BMI over 35 kg/m2. Thirty-eight percent of the excess risk of diabetes in people with a family history could be avoided if their BMI did not exceed 30 kg/m2. Individuals who reported sedentary occupations were at greater risk of diabetes compared to those reporting more active occupations. There was a synergistic effect of family history and self-reported occupational physical activity on diabetes risk. CONCLUSION: Individuals with a family history of diabetes are at increased risk for the metabolic consequences of obesity and form an easily identifiable group who may benefit from targeted intervention to prevent the development of obesity through increased physical activity.     

上海市长宁区社区人群原发性高血压患病现况及危险因素的调查

目的 通过对上海市长宁区社区人群的抽样调查,了解其高血压的患病率、知晓率和治疗率,并分析与高血压相关联的主要危险因素.方法：采取整群抽样的方法,随机抽取四个社区,对其中35～91岁且排除继发性高血压的自然人群19 519人 （男性8 673人,女性10 846人） 进行调查分析.结果 （1） 高血压的患病率、知晓率和治疗率分别为39.88%、84.74%和47.93%,三率均为65-91岁组高于35-64岁组（39.88%和22.27%,87.40%和78.74%,49.88%和43.53%,P〈0.05）;（2） 对高血压影响因素进行多因素 Logistic 回归分析,结果显示高血压与年龄、性别 （男性）、体质指数、家庭收入、摄盐量、父母高血压史及本人高脂血症史相关（P值均小于0.001）,年龄、性别、体质指数、父母高血压史、本人高脂血症史的OR值分别为1.064 （1.060-1.068）、1.098 （1.053～1.145）、1.134 （1.121-1.147）、1.831 （1.722～1.947）、1.507 （1.329-1.708）;以家庭年收入5万以下组为参照,5-10万和10万以上组 OR 值分别为 2.349 （1.559-3.540）和 2.462 （1.620-3.742）;以摄盐量 6-12g/d 组为参照,〈6g/d组和〉 12 g/d 组 OR 值分别为0.888 （0.832-0.947）和1.117 （1.016～1.227）.结论上海市长宁区社区人群≥65岁者高血压的患病率较高,而中青年高血压的知晓率和治疗率较低,特别是男性.年龄、男性、体质指数高、嗜盐、家庭收入高、高血压家族史及本人高脂血症史是高血压患病的主要危险因素.