糖尿病前期患病率调查的文献分析

目的了解我国糖尿病前期患病率研究的现状。方法借鉴循证医学全面文献检索的方法,运用noteExpress文献管理软件对下载文献进行管理,通过一定的纳入排除标准,对纳入文献进行文献计量分析。结果纳入的87篇文献发表在61种杂志上,各年份发表的文献基本呈逐年递增的趋势,现有的调查研究在人群和地区上的分布不均衡,文献报道中所采用的现场调查方式和诊断标准各不统一,各文献报道的患病率差异较大。结论应合理选择现场调查方式和选择公认的诊断标准,提高研究质量与数据的可比性;应加大对糖尿病前期研究的投入,尤其增加对西部地区研究的支持力度;增强医疗卫生领域在糖尿病前期研究中的主导作用。     

糖尿病前期人群血脂异常及危险因素分析

目的探讨糖尿病前期人群血脂异常的患病率及影响因素。方法选择就诊的糖尿病前期患者80例作为研究对象,根据血脂水平分为血脂正常组与血脂异常组。收集两组性别、年龄、婚姻状况、糖尿病家族史、吸烟史、饮酒史等一般资料,检测两组体质量指数(BMI)、腰臀比(WHR)、血压、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。比较两组血脂水平,采用单因素及多因素logistic回归分析糖尿病前期血脂异常的高危影响因素。结果血脂异常组TC、TG、HDL-C、LDL-C水平比血脂正常组高,差异有统计学意义(P0.05);年龄、饮酒、血压、BMI指数、WHR指数、静坐时间与糖尿病前期患者发生血脂异常有关,差异有统计学意义(P0.05);经logistic回归分析表明,年龄超过60岁、饮酒、血压高、BMI24、WHR指数偏高、静坐时间5h/d是糖尿病前期患者血脂异常发生的独立危险因素,差异有统计学意义(P0.05)。结论糖尿病前期血脂异常人群血脂水平显著高于血脂正常人群,影响糖尿病前期患者血脂异常高危独立因素有年龄超过60岁、饮酒、血压高、BMI24、WHR指数偏高、静坐时间5h/d。     

云南大理白族自治州成人糖尿病前期和糖尿病流行病学调查以及危险因素分析

目的 探讨云南大理白族自治州成人糖尿病前期及糖尿病的流行现状并分析相关危险因素.方法 采用多阶段、随机、整群抽样方法,对大理白族自治州主城区18岁以上常驻居民进行年度健康体检,共抽取5 439例为调查对象,以问卷收集资料并进行体格检查及实验室检查,采用横断面调查,统计不同年龄、性别组人群的糖尿病前期及糖尿病患病率并对相关危险因素进行分析.结果 ①云南大理白族自治州成人年龄标化后糖尿病前期患病率为20.55％(男性23.39％,女性18.74％),标化后糖尿病患病率为11.32％(男性12.21％,女性11.14％),男性糖尿病前期以及糖尿病患病率高于女性(P＜0.01);②随着年龄的增长,各年龄组糖尿病前期患病率逐渐增长,男性为5.18％、10.44％、26.32％、32.19％、39.30％,女性为5.87％、8.13％、21.82％、26.89％,28.77％;糖尿病的发病率随着年龄的增长亦逐渐增长,男性为1.55％、3.84％、13.43％、20.52％、22.97％,女性为1.51％、3.73％、11.48％、16.41％、19.14％.③空腹血糖受损(IFG)、单纯糖耐量受损(IGT)、联合空腹血糖受损和糖耐量受损(IFG+ IGT)、新诊断糖尿病、已经诊断糖尿病患病率分别为1.56％、9.64％、10.28％、6.74％、5.21％;在糖尿病前期患者中,IFG、IGT、IFG+IGT构成比分别占7.25％、44.89％、47.86％;在糖尿病患者中,新诊断的糖尿病占56.40％,已经诊断糖尿病占43.60％.④Logistic回归分析显示:年龄、性别、收缩压、体质量指数、静息心率、甘油三酯、总胆固醇、血尿酸、糖尿病家族史、脑卒中家族史为2型糖尿病的危险因素,高密度脂蛋白胆固醇、教育程度为保护性因素.结论 云南大理白族自治州成人糖尿病前期以及糖尿病流行状况严峻,该地区应建立健康的生活方式,强调血压、血糖、血脂、体质量的综合控制,加强糖尿病教育是防治2型糖尿病发生的重要措施.     

糖尿病前期病人焦虑患病状况及影响因素分析

[目的]了解糖尿病前期病人焦虑的患病状况及其影响因素,为糖尿病前期病人制定心理干预措施提供依据。[方法]采用便利取样法,选取江西省某三级甲等综合性医院门诊体检筛查出的糖尿病前期病人100例,进行个人基本信息、健康状况、焦虑自评量表问卷调查及体格检查。[结果]糖尿病前期病人焦虑得分为(41.32±9.50)分,焦虑患病率22%,其中轻度焦虑20例,中度焦虑2例,无重度焦虑。焦虑的影响因素是年龄、家庭月收入、葡萄糖耐量试验(OGTT)2h血糖。糖尿病前期病人焦虑与年龄、家庭月收入呈负相关(r=-0.160,r=-0.26,P0.05),与OGTT2h血糖呈正相关(r=0.034,P0.05)。[结论]年龄是糖尿病前期病人发生焦虑的独立保护因素,应关注糖尿病前期病人的焦虑情绪。     

糖尿病前期人群护理干预对血糖的影响

目的：探讨护理干预对糖尿病前期人群血糖水平的影响作用。方法：糖尿病前期患者30例,分析护理干预前与干预后的空腹血糖和餐后2 h血糖值的变化。结果：护理干预前与干预后血糖值的变化比较有统计学意义（P〈0.05）。结论：护理干预能有效降低糖尿病前期人群的血糖水平。     

社区健康督导对糖尿病前期人群转归的影响

[目的]观察社区健康督导对糖尿病前期人群转归的影响。[方法]将糖尿病前期120人随机分为对照组和干预组,干预组进行社区健康督导教育,活动方式为群体教育与个别谈话相结合,社区医护人员宣教与家属参与督导相结合,健康督导教育与糖尿病前期人群之间的互相交流相结合;定期组织糖尿病防治的科普知识讲座、印发健康教育宣传手册等。对照组不进行任何干预。2年后,观察这些人群的转归。[结果]两组在转归为糖尿病、正常糖代谢方面比较,干预组优于对照组(P<0.01)。[结论]社区健康督导可降低糖尿病的发生率。     

健康体检人群糖尿病相关知识调查分析

近几年来，随着世界各国经济发展和居民生活水平的提高，1型糖尿病和2型糖尿病的发病率逐年提高。目前全球糖尿病平均患病率为4％，总人数超过2亿。我国糖尿病患病率为3．2％～3．6％，患病人数约4000万，居世界第2位。     

糖尿病前期人群的医学营养干预研究

目的：对糖尿病前期患者进行医学营养干预并分析干预效果,为临床营养治疗提供实践依据。方法：从太原市敦化坊社区居民健康档案及健康体检中心筛选出糖尿病前期患者100例,随机分为干预组和对照组,每组50例。对干预组进行医学营养干预2个月后,比较两组人群的糖尿病相关知识知晓率、体重、空腹血糖（FPG）、餐后2h血糖（2hPPG）、三酰甘油（TG）、血清总胆固醇（TC）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）的变化。结果：干预前两组人群的各项指标有可比性（P〉0．05）。干预后,干预组的糖尿病相关知识知晓率明显提高（P〈0．05）,体重、FPG、2hPPG、TC、TG、LDL—C明显下降（P〈0．05）;对照组观察指标较前变化不明显（P〉0．05）。结论：医学营养干预能改善糖尿病前期的糖脂代谢,有效阻止糖尿病的发生,减少或延缓心血管病和微血管病等疾病的发生。     

社区健康督导对糖尿病前期人群转归的影响

[目的]观察社区健康督导对糖尿病前期人群转归的影响。[方法]将糖尿病前期120人随机分为对照组和干预组,干预组进行社区健康督导教育,活动方式为群体教育与个别谈话相结合,社区医护人员宣教与家属参与督导相结合,健康督导教育与糖尿病前期人群之间的互相交流相结合;定期组织糖尿病防治的科普知识讲座、印发健康教育宣传手册等。对照组不进行任何干预。2年后,观察这些人群的转归。[结果]两组在转归为糖尿病、正常糖代谢方面比较,干预组优于对照组(P<0.01)。[结论]社区健康督导可降低糖尿病的发生率。     

营养干预对糖尿病前期人群膳食摄入的影响研究

目的探讨营养干预对糖尿病前期人群膳食摄入的影响。方法将社区流行病学调查所获得的糖尿病前期人群随机分为营养干预组(n=57)和对照组(n=58)。干预组接受6个月的营养干预,对照组仅接受健康教育。结果干预组经过6个月的营养干预后,能量的摄入、脂肪的摄入、胆固醇的摄入、脂肪供能明显低于对照组,膳食纤维的摄入、碳水化合物供能明显高于对照组,其差异均有统计学意义(P0.01)。结论营养干预能有效改善社区糖尿病前期人群的膳食摄入结构,值得推广。     

慢性肝病并发肝原性糖尿病的易患因素分析

目的探讨肝原性糖尿病的患病率及其相关因素。方法对230例慢性肝病患者进行肝功能、血糖、胰岛素及瘦素水平检测,稳态模型估算胰岛素抵抗指数(HOMA-IR)。结果肝原性糖尿病的患病率为15.22%,该组空腹胰岛素水平(FINS)及IR较无糖代谢异常的肝病组高,(20.76±8.95)mU/L vs(15.74±7.28)mU/L和0.60±0.33 vs 0.46±0.25,差异有统计学意义(均P<0.05);两组血清瘦素水平(2.96±0.38)μg/L vs(2.82±0.45)μg/L,差别无统计学意义(P>0.05);Logistic逐步回归分析显示FINS(r=0.125)、HOMA-IR(r=0.235)与肝原性糖尿病的发生呈正相关(P<0.05)。结论肝原性糖尿病的患病率较高,高胰岛素血症和胰岛素抵抗是其发生的重要因素。     

Effect of vitamin D supplementation on glycose homeostasis and islet function in vitamin D deficient or insufficient diabetes and prediabetes: a systematic review and meta-analysis

Objective of the present study was to evaluate the effect of vitamin D supplementation on glycose homeostasis, islet function, and diabetes progress. Literatures were searched via electronic databases, websites, and previous reviews from the earliest available time to the end of May 2020. Randomized controlled trials initially designed for diabetes and prediabetes with 25-dihydroxyvitamin D [25(OH)D]<30 ng/ml were included. All data were analyzed and presented based on the Cochrane guidelines and PRISMA guidelines. In total, 27 articles (n = 1,932) were enrolled in this study. Vitamin D supplementation significantly improved fasting blood glucose, postprandial blood glucose, and quantitative insulin sensitivity check index in diabetes and prediabetes with baseline 25(OH)D<30 ng/ml. Higher percentages regressing from prediabetes to normal glucose status [1.60 (1.19, 2.17), p = 0.002, n = 564] and lower percentage progressing from prediabetes to diabetes [0.68 (0.36, 1.27), p = 0.23, n = 569] were found in the supplementation group. The positive effects of vitamin D supplementation on body mass index, waist, HDL-C, LDL-C, and CRP were also demonstrated. In conclusion, modest improvements in vitamin D supplementation on short-term glycose homeostasis, insulin sensitivity, and disease development in diabetes and prediabetes with 25(OH)D<30 ng/ml were demonstrated, but more research needs to be conducted in the future to support the clinical application. (Register ID: CRD42020186004)     

Electronic health record identification of prediabetes and an assessment of unmet counselling needs

Rationale, aims and objectives Large clinical trials demonstrate that lifestyle modification can prevent or delay the onset of diabetes in those with prediabetes. However, recent National Health and Nutrition Survey data suggest that prediabetes often goes unrecognized, and the majority of prediabetic individuals do not report having received lifestyle advice from physicians. We explored whether electronic health record (EHR) query of glucose measurements can identify prediabetic patients, and we estimated rates of prediabetic lifestyle counselling in a large, urban, primary care practice. Methods Electronic search identified patients with plasma glucose levels of 100 to 199 mg dL^?1 between 1 June 2007 and 1 June 2009, excluding those with diabetes or diabetic medications/supplies. From these 5366 patients, 100 randomly selected patients underwent classification into provisional categories based on available EHR data: likely prediabetes, likely diabetes, glucose abnormality in the setting of acute illness, or normal glucose metabolism. In those likely to have prediabetes, we assessed lifestyle modification counselling. Results Fifty‐eight per cent (95% CI 48% to 68%) of patients sampled were likely to have prediabetes. Fourteen per cent of those sampled were likely to have diabetes. Thirty‐one per cent of prediabetics (95% CI 22% to 42%) had documented lifestyle counselling. Counselled patients had a significantly higher baseline mean body mass index compared to those not counselled (34.1 versus 29.9, P = 0.037). Conclusions EHR query using glucose measurements can identify prediabetic patients and those requiring further glucose metabolism evaluation, including those with undiagnosed diabetes. Future research should investigate EHR‐based, population‐level interventions to facilitate prediabetes recognition and counselling.     

Detection of Undiagnosed Diabetes and Prediabetic States in High-risk Emergency Department Patients

Background: Diabetes is often not diagnosed until complications appear, and one‐third of those with diabetes may be undiagnosed. Prediabetes and diabetes are conditions in which early detection would be appropriate, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Objectives: The objectives were to determine the prevalence of diabetes mellitus and prediabetes in emergency department (ED) patients with an elevated random glucose or risk factors for diabetes but without previously diagnosed diabetes and to identify which at‐risk ED patients should be considered for referral for confirmatory diagnostic testing. Methods: This two‐part study was composed of a prospective 2‐year cohort study, and a 1‐week cross‐sectional survey substudy, set in an urban ED in Los Angeles County, California. A convenience sample was enrolled of 528 ED patients without previously diagnosed diabetes with either 1) a random serum glucose ≥ 140 mg/dL regardless of the time of last food intake or a random serum glucose ≥ 126 mg/dL if more than 2 hours since last food intake or 2) at least two predefined diabetes risk factors. Measurements included presence of diabetes risk factors, ED glucose, cortisol, insulin and glycosylated hemoglobin (HbA_1c), and 2‐hour oral glucose tolerance test results, administered at 6‐week follow‐up. Results: Glycemic status was confirmed at follow‐up in 256 (48%) of the 528 patients. Twenty‐seven (11%) were found to have diabetes, 141 (55%) had prediabetes, and 88 (34%) had normal results. Age, ED glucose, HbA_1c, cortisol, and random serum glucose ≥ 140 mg/dL were associated with both diabetes and prediabetes on univariate analysis. A random serum glucose ≥ 126 mg/dL after 2 hours of fasting was associated with diabetes but not prediabetes; ED cortisol, insulin, age ≥ 45 years, race, and calculated body mass index (BMI) were associated with prediabetes but not diabetes. In multivariable models, among factors measurable in the ED, the only independent predictor of diabetes was ED glucose, while ED glucose, age ≥ 45 years, and symptoms of polyuria and polydipsia were independent predictors of prediabetes. All at‐risk subjects with a random ED blood glucose > 155 mg/dL had either prediabetes or diabetes on follow‐up testing. Conclusions: A substantial fraction of this urban ED study population was at risk for undiagnosed diabetes and prediabetes, and among the at‐risk patients referred for follow‐up, the majority demonstrated diabetes or prediabetes. Notably, all patients with two risk factors and a random serum glucose > 155 mg/dL were later diagnosed with prediabetes or diabetes. Consideration should be given to referring ED patients with risk factors and a random glucose > 155 mg/dL for follow‐up testing.