糖耐量低减患者的健康教育

实施口服葡萄糖耐量试验（OGTT）2小时静脉血浆葡萄糖水平≥7．8mmol／L,〈11．1mmol／L是界于糖尿病和正常血糖之间的、非均质的并处于动态变化之中的一种特殊代谢状态,被称为糖耐量低减（impaired glucose tolerance,IGT）。     

Comparison of metabolic risk profiles between subjects with fasting and 2-hour plasma glucose impairment: The Kinmen Study.

A two-step screening strategy was used to compare the metabolic risk profiles between subjects from Kinmen, Taiwan, who had fasting and 2-hr plasma glucose impairment and were considered at high risk of diabetes due to a fasting plasma glucose (FPG) between 5.6 and 7.8 mmol/l at the baseline screening. 1855 subjects without a previous diagnosis of diabetes who had an FPG of 5.6-7.8 mmol/l at the first step of screening were invited to undergo an Oral Glucose Tolerance Test (OGTT) for the second step of screening, and 1456 of these subjects (774 males and 682 females) completed the OGTT. Subjects who completed the OGTT were classified into normal, isolated impaired fasting glucose (isolated IFG), isolated impaired glucose tolerance (isolated IGT), both IFG and IGT, or undiagnosed diabetes groups. Sex-specific, age-adjusted mean values of metabolic risk profiles for various categories of glucose intolerance were calculated. The results for IFG and IGT agreed in only 20.8% of subjects. The clinical features of subjects with IGT (2-hr glucose impairment) were associated with cardiovascular risk profiles, while those subjects with isolated IFG (fasting glucose impairment only) were not. If the definition of IFG alone had been used for glucose intolerance screening, about 66.6% of subjects with IGT (i.e., isolated IGT with 2-hr glucose impairment and a normal fasting state) who had cardiovascular risk profiles would have been undetected.     

糖化血红蛋白与口服糖耐量试验诊断糖尿病的比较研究

目的比较糖化血红蛋白(HbA1c)与口服糖耐量试验(OGTT)在一般人群中筛检糖尿病和糖尿病前期的效果。方法测定2010年中国居民营养与健康调查中江西省南昌市和湖北省武汉市的1416名调查对象的HbA1c,比较两种方法诊断的患者分布及血糖水平。用受试者工作特征曲线分析HbA1c诊断糖尿病的灵敏度和特异度。结果根据1999年WHO标准,研究对象中糖尿病、糖调节受损(IGR)患者分别为86例和262例。与OGTT相比,HbA1c≥6.5%的灵敏度为41.9%,特异度为98.9%。HbA1c标准与OGTT标准检出的糖尿病患者例数不同,两部分人群的HbA1c水平不同。HbA1c 5.7%~6.4%筛检IGR的灵敏度为78.6%,特异度为55.1%。HbA1c 5.7%~6.4%与IGR检出的患者不同,HbA1c 5.7%~6.4%患者的空腹血糖及餐后2 h血糖水平均低于IGR患者。结论 HbA1c≥6.5%诊断糖尿病特异度较高但灵敏度较低。HbA1c 5.7%~6.4%筛查糖尿病前期的价值较低。     

Subjects with impaired glucose tolerance exhibit a high degree of tolerance to honey

The present study compared the relative tolerance to honey and glucose of subjects with impaired glucose tolerance or mild diabetes. Thirty individuals 35-60 years old with a proven parental (mother or father) history of type II diabetes mellitus were subjected simultaneously to an oral glucose tolerance test (GTT) and a honey tolerance test (HTT). Glucose tolerance was found to be impaired in 24 subjects, while six of the subjects were diagnosed as mildly diabetic. All subjects with impaired glucose tolerance exhibited significantly lower plasma glucose concentrations after consumption of honey at all time points of the HTT in comparison to the GTT. The plasma glucose levels in response to honey peaked at 30-60 minutes and showed a rapid decline as compared to that to glucose. Significantly, the high degree of tolerance to honey was recorded in subjects with diabetes as well, indicating a lower glycemic index of honey. Thus, it is evident from the present investigation that honey may prove to be a valuable sugar substitute for subjects with impaired glucose tolerance or mild diabetes.     

More severe impairment of oral than intravenous glucose tolerance in rats after eating a high fat diet

Glucose and insulin responses to oral and intravenous glucose (1 g/kg body weight) were measured after consumption of a high fat (HF) or low fat (LF) diet for 3 wk in conscious rats with implanted intravenous and intra-arterial catheters. The HF diet resulted in impaired glucose tolerance and insulin resistance after both oral and intravenous glucose; the effect was more pronounced after oral glucose. In an attempt to understand the basis of the impairment of glucose tolerance after consuming the HF diet, the activity of hepatic glucokinase and the rate of intestinal glucose uptake were also measured. The more severe impairment of glucose tolerance by oral rather than intravenous administration was not explained by an increased rate of intestinal glucose uptake. Indeed, there was a small but significant reduction in the rate of jejunal glucose uptake in the HF rats. However, the greatly reduced activity of hepatic glucokinase in the HF rats was consistent with a reduced capacity for hepatic glucose uptake, which may have contributed significantly to the impaired glucose tolerance. The effects of the HF diet on the insulin response to glucose were much more pronounced after oral rather than intravenous glucose administration. This indicated that the HF diet may have stimulated the enteroinsular axis. However, it is also possible that the particularly high circulating insulin levels, resulting from oral glucose in the HF rats, were a direct response to hyperglycemia, secondary to reduced glucose removal.     

高血压合并糖耐量减低患者的心率变异性

【摘要】目的观察原发性高血压（EH）及EH合并糖耐量减低（IGT）患者心率变异性（HRV）的变化,探讨EH、EH合并IGT患者自主神经功能的改变。方法从门诊体检人群中筛选病例166例,其中EH组62例,EH合并IGT组56例,健康对照组48例,测定HRV及相关生化指标。结果EH组与健康对照组比较,R-R间期的标准差（SDNN）、5min窦性R-R间期平均值的标准差（SDANN）、每5min窦性R-R间期标准差的平方根（SDNNi）、窦性相邻R-R间期差值〉50ms的心搏数占窦性总搏数的百分比（PNN50）均下降,C肽、高敏C反应蛋白（hs．CRP）升高,差异有统计学意义（P〈0．05）。EH合并IGT组与健康对照组比较,SDNN、SDANN、SDNNi、相邻R．R间期之差的均方根（rMSSD）、PNN50均下降,C肽、胰岛素、hs-CRP升高,差异有统计学意义（P〈0．01）。EH合并IGT组与EH组比较,rMSSD、PNN50下降明显,差异有统计学意义（P〈0．叭）;C肽、胰岛素、hs—CRP升高,差异有统计学意义（P〈O．05或〈0．01）。结论EH、EH合并IGT者HRV指标均下降,提示存在自主神经功能损害,且后者更严重,可能与胰岛素抵抗、hs—CRP升高相关。     

Relationship between major dietary patterns and metabolic syndrome among individuals with impaired glucose tolerance

ObjectiveDietary habits have been associated with the prevalence of the metabolic syndrome and limited data are available in this field for individuals with impaired glucose tolerance. This study focused on the association between major dietary patterns and prevalence of the metabolic syndrome in individuals with impaired glucose tolerance.MethodsThis cross-sectional study was done in 425 subjects 35 to 55 y of age. Dietary data were collected using a food-frequency questionnaire. Blood pressure, waist circumference, glucose, triacylglycerols, and high-density lipoprotein cholesterol were measured and metabolic syndrome was defined based on Adult Treatment Panel III guidelines.ResultsFive major dietary patterns were found: a western pattern (high in sweets, butter, soda, mayonnaise, sugar, cookies, tail of a lamb, hydrogenated fat, and eggs), a prudent pattern (high in fish, peas, honey, nuts, juice, dry fruits, vegetable oil, liver and organic meat, and coconuts and low in hydrogenated fat and non-leafy vegetables), a vegetarian pattern (high in potatoes, legumes, fruits rich in vitamin C, rice, green leafy vegetables, and fruits rich in vitamin A), a high-fat dairy pattern (high in high-fat yogurt and high-fat milk and low in low-fat yogurt, peas, and bread), and a chicken and plant pattern (high in chicken, fruits rich in vitamin A, green leafy vegetables, and mayonnaise and low in beef, liver, and organic meat). After adjusting for confounding variables, the western pattern was associated with greater odds of having increased triacylglycerol (odds ratio 1.76, 95% confidence interval 1.01–3.07) and blood pressure (odds ratio 2.62, 95% confidence interval 1.32–5.23). The prudent pattern was positively associated with a prevalence of low high-density lipoprotein cholesterol levels (odds ratio 0.55, 95% confidence interval 0.31–0.96). The vegetarian dietary pattern was inversely associated with a risk of an abnormal fasting blood glucose level (odds ratio 2.26, 95% confidence interval 1.25–4.06).ConclusionMajor dietary patterns were significantly associated with the risk of metabolic syndrome.     

脑白质疏松症患者的记忆障碍特点与执行功能相关性分析

目的 研究脑白质疏松症（leukoaraiosis,LA）患者记忆障碍的特点和执行功能,并进一步了解记忆障碍与执行功能的相关性。方法 采用听觉词汇学习测验（auditory verbal learning test,AVLT）评价LA患者的记忆障碍特点和Stroop色词测验评估患者执行功能,对46例LA患者和46例年龄及受教育程度相匹配的对照者进行研究。结果 LA组较对照组在AVLT即刻回忆、延迟回忆成绩差异均无统计学意义（均有P>0.05）,在延迟再认成绩上差异有统计学意义（t=-2.306,P=0.026）。LA组较对照组在Stroop色词测验中卡片C（色字）和干扰效应（stroop interfere effects,SIE）成绩差异均有统计学意义（均有P<0.05）,而在卡片A（点）和卡片B（字）成绩差异均无统计学意义（均有P>0.05）。且LA组延迟再认成绩与SIE呈负相关（r=-0.768,P=0.003）,即SIE越明显则延迟再认成绩越差。结论 LA患者的记忆障碍特点是以信息提取的能力下降为主,考虑可能与LA患者执行功能下降导致的注意和抑制能力下降有关。     

Diet and glucose tolerance in a Chinese population

BACKGROUND: Associations between dietary factors and glucose tolerance observed in Caucasian populations may not be applicable to Chinese populations, since the traditional Chinese diet contains plentiful vegetables and is rice-based (which has a lower glycemic index than potatoes). To address this question, the dietary patterns in 988 Hong Kong Chinese subjects with normal and impaired glucose tolerance, and diabetes, were examined in a cross sectional survey to determine if there is any association between diet and glucose tolerance. METHOD: A stratified random population sample of 988 subjects (488 male, 500 female) was recruited. A food frequency questionnaire was used to determine dietary intake, and glucose tolerance was examined using the glucose tolerance test and the WHO criteria used to classify subjects into the three glucose tolerance categories. RESULTS: Using the standardized world population of Segi, the prevalence rate for DM was 6.6% for men and 5.7% for women; and for IGT 10.3% for men and 15.4% for women aged 30-64 y. Abnormal glucose tolerance is associated with female gender, older age, lower educational attainment and higher body mass index (BMI). No clear pattern of association with dietary factors was observed after adjusting for confounding factors. However, if subjects with BMI>or=25 kg/m(2) were excluded, an increase in mean consumption of rice/noodles/pasta per week was observed in the DM group, after adjusting for total energy intake and other confounding factors. No association between dietary variety, which has been linked with body fatness, and glucose tolerance, was observed. CONCLUSION: Dietary habit may not be a strong risk factor for the development of glucose intolerance in Chinese populations, given the favorable features of the Chinese diet. The high consumption of rice in the DM subjects who are of normal BMI suggests that further studies examining glycemic indices of Chinese food items may be beneficial. Obesity still remains the most important predisposing factor.     

糖尿病和糖耐量低减患者生命质量评价

目的 了解糖尿病和糖耐量低减患的生命质量,并探讨其影响因素。方法 采用SF-36量表评价：108例糖尿病、109例糖耐量低减和116例糖耐量正常的生命质量,并研究其影响因素。结果 糖尿病患中,自我确认健康感觉非常好或很好占12．04％,与同龄人比较,健康感觉好或较好占62．04％;糖耐量低减患中上述比例较高,分别为13．76％和69．72％;生命质量综合评分很好或好的比例在糖尿病患为72．23％,糖耐量低减患为83．49％。糖尿病患生命质量已普遍下降,生命质量各维度评分最低为情绪角色功能,最高为躯体功能,波动在58．33-87．38之间,其中躯体功能、躯体角色功能、总体健康、精力和综合评分显低于糖耐量正常,精力、心理健康和综合评分显低于糖耐量低减;糖耐量低减患生命质量各维度有不同程度的损害,但其生命质量评分与糖耐量正常无统计学差异。相关分析显示,年龄、职业、离退休、病程、糖尿病症状数、并发症数量、空腹血糖和餐后2h血糖水平对糖尿病患生命质量有影响。结论 提高糖尿病患的生命质量,应该从疾病早期开始。控制血糖稳定,重视患的心理治疗和采取有针对性的措施,可提高不同特征患的生命质量。     

糖耐量及胰岛素水平测定在多囊卵巢综合征中的临床应用

目的探讨多囊卵巢综合征患者（PCOS）糖代谢和胰岛素水平的改变。方法 173例PCOS患者按体质量指数（BMI）分为PCOS非肥胖组（BMI〈25kg/m2）、PCOS肥胖组（BMI≥25kg/m2）和42例正常对照组,各组均做口服糖耐量和胰岛素释放试验。结果与对照组相比,PCOS非肥胖组的空腹和口服葡萄糖后,1、2和3h的血糖差异均无统计学意义（P〉0.05）,胰岛素水平均有显著升高（P〈0.05）。PCOS肥胖组的空腹及口服葡萄糖后,1、2和3h的血糖和胰岛素水平均显著高于对照组和PCOS非肥胖组（P〈0.05）,差异具有统计学意义。结论 PCOS患者存在糖代谢异常和高胰岛素血症,口服糖耐量试验是用于监测育龄妇女PCOS患者糖代谢的较好指标。     

妊娠合并糖代谢异常孕妇动态血糖图谱变化分析

目的:探讨妊娠糖尿病与糖尿病合并妊娠孕妇的动态血糖图谱变化特征,为临床治疗提供参考。方法:对妊娠糖尿病与糖尿病合并妊娠孕妇128例进行72h连续血糖图谱分析。结果:糖尿病合并妊娠组(65例)空腹血糖值、血糖波动系数、低血糖发生率高于妊娠糖尿病组(63例),妊娠糖尿病组血糖达峰时间长且低血糖发生少。结论:妊娠糖尿病患者与糖尿病合并妊娠患者在基线空腹血糖值及糖化血红蛋白值一致的情况下,动态血糖图谱仍存在差异,动态血糖图谱能够反映妊娠合并糖代谢异常孕妇的血糖波动全貌,为精细调节糖代谢和个体化用药提供参考。     

Comparison of tolerance and nutritional outcome between a peptide and a standard enteral formula in critically ill, hypoalbuminemic patients.

Dipeptides have been reported to be more efficiently absorbed from the gastrointestinal tract than free amino acids. The objective of this study was to compare prospectively a peptide enteral formula (PEF) with a standard enteral formula (SEF) for tolerance and nutritional outcome in acutely injured, hypoalbuminemic (less than 3.0 g/dL) patients who require enteral nutrition support. The prevalence of diarrhea and elevated gastric residuals was assessed daily. Prealbumin, transferrin, colloid oncotic pressure, Prognostic Nutritional Index, and nitrogen balance were measured on days 0, 5, and 10 of enteral nutrition support. Forty-one patients received 345 days of enteral nutrition support. Prevalences of diarrhea and elevated gastric residuals were similar between groups. Prealbumin increased and the Prognostic Nutritional Index decreased significantly from baseline at day 10 in both groups. Transferrin increased in both groups, but not significantly. Colloid oncotic pressure increased significantly from baseline at days 5 and 10 in the SEF group and day 10 in the PEF group. Nitrogen balance increased significantly from baseline at days 5 and 10 in each group. The only significant difference between groups was for nitrogen balance at day 10, which was higher in the SEF group. We conclude based upon our selected measurements of tolerance and nutritional outcome PEF seems to offer no advantage over SEF in acutely injured, hypoalbuminemic patients.     

糖耐量试验观察冠心病糖代谢异常的临床研究

目的:研究糖耐量试验观察冠心病糖代谢异常对冠脉病变程度的影响。方法:随机选择142例进行冠脉造影术的非糖尿病患者,其中70例确诊冠心病为观察组,根据冠脉病变程度再分轻重2组,72例非冠心病患者为对照组,均进行糖耐量试验及糖化血红蛋白测定。结果:冠心病组餐后2 h血糖(9.53±3.24)mmol/L,高于非冠心病组(6.47±1.52)mmol/L,P<0.05;冠脉狭窄程度与餐后2 h血糖之间呈显著性低度正相关(r为0.337,P<0.01)。结论:冠心病患者糖耐量受损明显,糖耐量试验对冠心病糖代谢异常的临床观察具有重要性。     

Supplementation of hydrogen-rich water improves lipid and glucose metabolism in patients with type 2 diabetes or impaired glucose tolerance

Oxidative stress is recognized widely as being associated with various disorders including diabetes, hypertension, and atherosclerosis. It is well established that hydrogen has a reducing action. We therefore investigated the effects of hydrogen-rich water intake on lipid and glucose metabolism in patients with either type 2 diabetes mellitus (T2DM) or impaired glucose tolerance (IGT). We performed a randomized, double-blind, placebo-controlled, crossover study in 30 patients with T2DM controlled by diet and exercise therapy and 6 patients with IGT. The patients consumed either 900 mL/d of hydrogen-rich pure water or 900 mL of placebo pure water for 8 weeks, with a 12-week washout period. Several biomarkers of oxidative stress, insulin resistance, and glucose metabolism, assessed by an oral glucose tolerance test, were evaluated at baseline and at 8 weeks. Intake of hydrogen-rich water was associated with significant decreases in the levels of modified low-density lipoprotein (LDL) cholesterol (ie, modifications that increase the net negative charge of LDL), small dense LDL, and urinary 8-isoprostanes by 15.5% (P < .01), 5.7% (P < .05), and 6.6% (P < .05), respectively. Hydrogen-rich water intake was also associated with a trend of decreased serum concentrations of oxidized LDL and free fatty acids, and increased plasma levels of adiponectin and extracellular-superoxide dismutase. In 4 of 6 patients with IGT, intake of hydrogen-rich water normalized the oral glucose tolerance test. In conclusion, these results suggest that supplementation with hydrogen-rich water may have a beneficial role in prevention of T2DM and insulin resistance.     

Cost-effectiveness analysis of acarbose in the treatment of patients with impaired glucose tolerance

OBJECTIVE: To perform a cost-effectiveness analysis of treatment with acarbose in patients with impaired glucose tolerance (IGT) in comparison with conventional treatment (based on medical counseling on diet and health and without drug treatment) from the perspective of the public payer. MATERIAL AND METHOD: A cost-effectiveness analysis was performed using data on efficacy, the incidence of diabetes mellitus type 2 (DM2) and cardiovascular events from the STOP-NIDDM clinical trial of acarbose treatment vs. placebo. The study used a decision tree analysis to estimate the health and economic impact of the two alternative treatments in a population of 1,000 patients over a period of 40 months. Resource use and cost data refer to the Spanish health care system. RESULTS: In the base case, acarbose treatment was slightly dominant over conventional treatment since it achieved improved outcomes at an even lower cost. Sensitivity analysis revealed that acarbose treatment lost dominance due to a moderately positive cost-effectiveness ratio for avoided progression to DM2 in some scenarios. The cost-effectiveness ratio was particularly sensitive to the cost of cardiovascular treatments, the risk of progression to DM2, the daily doses of acarbose, and the publicly funded share of the cost of this drug. CONCLUSIONS: Acarbose treatment in patients diagnosed with IGT appeared to be the dominant alternative compared with conventional treatment. The cost per avoided progression to DM2 and per additional individual free of a cardiovascular event was moderately low in some of the scenarios included in the sensitivity analysis. For a more comprehensive evaluation of the possible treatment of patients with IGT, the alternatives under comparison and the time horizon of the study would need to be increased and more refined health outcome measures, comprising all the treatment's health effects, would need to be introduced.     

阿卡波糖对糖耐量减低患者血管内皮功能的保护

目的 观察阿卡波糖对糖耐量减低患者血管内皮功能的影响.方法 根据口服葡萄糖耐量试验选择56例糖耐量减低(IGT)患者,按系统抽样法随机分为对照组27例和治疗组29例.对照组口服安慰剂,治疗组口服阿卡波糖25～50 mg,3次/d,连续12周.测定两组治疗前后体质指数、血脂、空腹血糖(FPG)、空腹胰岛素、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、血管性血友病因子(vWF)、餐后2h血糖和餐后2h胰岛素及肱动脉内皮依赖性舒张功能(EDD).结果 与治疗前比较,治疗组患者治疗后体质指数、餐后2h血糖、餐后2h胰岛素、HbA1c、hs-CRP、vWF明显降低[(24.69±2.62) kg/m2比(22.02±2.59) kg/m2; (9.26±1.02) mmol/L比(7.43±0.95) mmol/L;(42.17±9.98) U/L比(34.76±9.86) U/L; (6.03±0.67)％比(5.37±0.56)％;(5.45±1.93) mg/L比(4.52±1.55) mg/L;( 187.22±26.57)％比(165.13±23.86)％] (P＜ 0.05或＜0.01),EDD明显增大[(6.08±1.22)％比(7.94±1.25)％](P＜0.01).对照组治疗前后各指标比较差异无统计学意义(P＞0.05).结论 阿卡波糖可以降低IGT患者餐后血糖,并减轻机体胰岛素抵抗,减少炎性因子,改善血管内皮功能,延缓糖尿病的发生及动脉粥样硬化的发展.