老年空腹血糖受损者进展为糖尿病的状况分析

目的:分析老年空腹血糖受损(IFG)者进展为糖尿病(DM)的情况。方法:依据2003年美国糖尿病学会提出的IFG诊断标准,140例老年IFG者被分为原IFG组(63例)、新增IFG组(77例),定期随访4年。结果:入选两组IFG患者间的血脂、血压、人体质量指数(BMI)均值水平均无明显差异(P0.05);在4年随访期间,原IFG组进展为DM者的比率为26.98%,明显高于新增IFG组的18.18%(P0.05),是新增IFG组的1.5倍;原IFG组年均进展为DM者的比率为8.90%,是新增IFG组(6.0%)的1.5倍;两组IFG者空腹血糖转为正常者无明显差异(P0.05)。结论:原IFG组不仅进展为DM者的比率明显高于新增组,而且进展速度也快于新增组,原IFG者发生糖尿病的危险性明显高于新增IFG者。     

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia.

AIMS: To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance. METHODS: Men (1223) and women (1370) aged 45-64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register. RESULTS: During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72-0.82) than for fasting glucose (0.65, 0.58-0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4-6.2) than for isolated IFG (2.3, 0.9-5.7) as compared with subjects with neither IFG nor IGT. CONCLUSION: Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention.     

High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius

OBJECTIVE: To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS: The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. CONCLUSIONS: In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.     

Impact of laparoscopic adjustable gastric banding on type 2 diabetes

Bariatric surgery is becoming an accepted option for obese people with type 2 diabetes. Our aim was to assess the impact of laparoscopic adjustable gastric banding (LAGB) through a systematic review of the literature. Data was sourced from Scopus, MEDLINE and EMBASE published from 2000 through May 2011, and five unpublished studies that were performed by industry for regulatory approval were also included. Studies were selected on the basis that they provide some detail of diabetes status before and after LAGB. There were 35 studies meeting the inclusion criteria. There was considerable heterogeneity in study design, sample size, length of follow‐up, attrition rates and classification of diabetes status. Weight loss was progressive over the first 2 years with a weighted average of 47% excess weight loss at 2 years. Remission or improvement in diabetes varied from 53% to 70% over different time periods. Results were broadly consistent, demonstrating clinically relevant improvements in diabetes outcomes with sustained weight loss in obese people with type 2 diabetes following LAGB surgery. However, there were significant shortcomings in the reviewed literature with few high‐quality studies, inconsistent reporting of diabetes outcomes and high attrition rates. Long‐term studies that address these limitations are needed.     

Laparoscopic adjustable gastric banding induces prolonged satiety: a randomized blind crossover study

The sustainability of surgically induced weight loss implies that energy homeostasis is favorably altered. We investigated the hypothesis that laparoscopic adjustable gastric banding (LAGB) induces prolonged satiety and that plasma ghrelin is involved. Seventeen weight-stable subjects who had achieved LAGB-induced weight loss attended blind crossover breakfast tests, one with optimal band restriction and one with reduced restriction. Standardized meals were consumed (0900 h) after 14-h fasting. Satiety visual analog scales were completed hourly (0700-1100 h) before and after feeding. Blood glucose, plasma insulin, ghrelin, and leptin levels were measured. Seventeen body mass index-matched controls were tested. Optimal restriction was associated with significantly greater fasting and postprandial satiety levels than reduced restriction (P < 0.01). Glucose, insulin, ghrelin, and leptin levels did not alter between optimal and reduced restriction. LAGB subjects displayed higher ghrelin (+12%, P = 0.13) and lower glucose (-17%, P = 0.018), insulin (-33%, P = 0.016), and leptin (-32%, P = 0.05) 4-h area under the curve levels than controls. Optimal LAGB restriction increased fasting and postprandial satiety levels. This supports the hypothesis that LAGB provides prolonged satiety, present even during fasting, favorably influencing energy homeostasis. Plasma insulin, leptin, and ghrelin appeared unrelated to the satiety effect and displayed orexigenic compensatory changes. Identifying the mechanisms underlying LAGB-induced satiety may assist the understanding of human energy homeostasis and obesity.     

糖代谢异常和糖尿病患者颈动脉粥样硬化的观察

目的:探讨糖尿病、糖代谢异常患者颈动脉粥样硬化的情况。方法:通过多普勒超声检查颈动脉粥样硬化的方法,观察了糖尿病、糖代谢异常患者颈动脉粥样硬化斑块的发生率及内中膜厚度,并与正常对照组进行比较。结果:糖尿病、糖代谢异常的患者与正常对照组相比其颈动脉粥样硬化斑块的发生率及内中膜厚度显著增加(P<0.01)。结论:糖尿病、糖代谢异常与颈动脉粥样硬化相互关联。     

Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding

AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.     

Pulmonary complications following laparoscopic adjustable gastric banding

Laparoscopic adjustable silicone banding (LAP-BAND) has rapidly gained acceptance and is now considered the most common bariatric operation. The accumulated experience with LAP-BAND has established this surgical method as safe and effective. However, no data have been issued concerning pulmonary complications following the procedure. We have recently experienced 3 cases of pulmonary complications following LAP-BAND surgery: 1 patient with pulmonary cavitation and 2 with bronchiectasis. Pulmonary physicians should be aware of the possibility of long-term pulmonary complications in patients who have undergone LAP-BAND surgery.     

综合干预对老年糖调节异常患者的影响

目的分析综合干预对老年血糖调节异常(IGR)患者进展为糖尿病的情况。方法对177例老年IGR患者(干预组)的生活方式进行4年综合干预,同期选择55例不进行综合干预的IGR患者作为对照组,分析空腹血糖受损、糖耐量异常患者进展为糖尿病的情况。结果干预组患者空腹血糖受损、糖耐量异常、空腹血糖受损合并糖耐量异常进展为糖尿病的比率分别为17.14%、20.99%和42.31%,空腹血糖受损合并糖耐量异常进展为糖尿病的比率分别是空腹血糖受损、糖耐量异常的2.47、2.02倍。与对照组比较,干预组空腹血糖受损、糖耐量异常患者进展为糖尿病的比率分别减少了55.01%和52.77%(P0.05,P0.01)。结论综合干预能有效控制与消弱心血管疾病危险因素,阻止或延缓IGR患者进展为糖尿病。     

老年空腹血糖受损62例进展研究

目的分析老年空腹血糖受损者(IFG)8年间进展情况。方法于2002年5～6月对我区离退休老干部中IFG行口服75g葡萄糖试验(OGTT),选取单纯空腹血糖受损者(I-IFG)62例,依据2003年美国糖尿病学会IFG诊断标准,将空腹血糖(FPG)为5.6～6.09mmol/L的受损者分为新增IFG组(A组),空腹血糖为6.1～6.99mmol/L的受损者分为原IFG组(B组),定期随访8年。结果基线时2组IFG者的血压、血脂、体质量指数(BMI)等临床指标差异均无统计学意义(P>0.05)。至随访结束时,A组进展为糖尿病(DM)的比率为20.59%,B组IFG进展为DM的比率为46.43%,是A组的2.25倍,差异有统计学意义(P<0.05);2组IFG逆转为糖耐量正常(NGT)、仍保持I-IFG以及进展为空腹血糖受损合并糖耐量受损(IFG/IGT)者的比率差异均无统计学意义(P>0.05)。全部IFG进展为DM的比率是32.25%,逆转为NGT的比率是14.52%,仍维持在I-IFG或IFG/IGT状态的比率是53.23%。结论 IFG诊断标准下调后,IFG患病率明显上升,但新增IFG进展为DM的风险明显低于原IFG。     

Progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screening programme in general practice: the ADDITION Study,Denmark

AIMS/HYPOTHESIS: To estimate the 1-year progression rates from both IFG and IGT to diabetes in individuals identified in a pragmatic diabetes screening programme in general practice (the ADDITION Study, Denmark [Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care]). METHODS: Persons aged 40-69 years were screened for type 2 diabetes based on a high-risk, stepwise strategy. At baseline, anthropometric measurements, blood samples and questionnaire data were collected. A total of 1,160 persons had IFG or IGT at baseline: 811 (70%) accepted re-examination after 1 year. Glucose tolerance classification was based on the 1999 WHO definition. At follow-up, diabetes was based on one diabetic glucose value of fasting blood glucose or 2-h blood glucose. RESULTS: At baseline, 308 persons had IFG and 503 had IGT. The incidence of diabetes was 17.6 and 18.8 per 100 person-years in the two groups, respectively. CONCLUSIONS/INTERPRETATION: IFG and IGT identified in general practice during a stepwise, high-risk screening programme for type 2 diabetes have high 1-year progression rates to diabetes. Consequently, intensive follow-up and intervention strategies are recommended for these high-risk individuals.     

硫化氢对老年空腹血糖调节受损和2型糖尿病的影响

目的 通过检测老年空腹血糖调节受损（IFG）和2型糖尿病患者的血清硫化氢（H2S）水平,探讨气体分子H2S在老年空腹血糖调节受损和2型糖尿病中的临床意义.方法 2型糖尿病患者66例,空腹血糖调节受损患者36例,正常对照组33例,检测入选者的血清H2S浓度.结果 与对照组相比,空腹血糖调节受损患者和2型糖尿病患者HOMA-IR指数明显升高[（3.24±0.93）、（2.34±1.12）比（1.70±1.10）,P＜0.05]、HOMA-β指数降低[（76.41±26.20）、（36.13±23.37）比（93.00±40.46）,P＜0.05],血清H2S水平明显升高[（60.93±12.95）、（63.64±10.96）比（50.07±10.85） μmol/L,P＜0.05].Pearson相关分析结果显示,H2S浓度与空腹血糖调节受损组和糖尿病组患者HOMA-β均呈显著负相关（γ值分别为-0.65、-0.69,P＜0.05）,与HOMA-IR均呈显著正相关（γ值分别为0.73、0.76,P＜0.05）.结论 内源性H2S可能通过抑制β细胞功能和增强胰岛素抵抗参与空腹血糖调节受损和2型糖尿病的发病过程.     

Screening for impaired fasting glucose and diabetes using available health plan data

AimsTo develop and validate prediction equations to identify individuals at high risk for type 2 diabetes using existing health plan data.MethodsHealth plan data from 2005 to 2009 from 18,527 members of a Midwestern HMO without diabetes, 6% of whom had fasting plasma glucose (FPG) ≥ 110 mg/dL, and health plan data from 2005 to 2006 from 368,025 members of a West Coast-integrated delivery system without diabetes, 13% of whom had FPG ≥ 110 mg/dL were analyzed. Within each health plan, we used multiple logistic regression to develop equations to predict FPG ≥ 110 mg/dL for half of the population and validated the equations using the other half. We then externally validated the equations in the other health plan.ResultsAreas under the curve for the most parsimonious equations were 0.665 to 0.729 when validated internally. Positive predictive values were 14% to 32% when validated internally and 14% to 29% when validated externally.ConclusionMultivariate logistic regression equations can be applied to existing health plan data to efficiently identify persons at higher risk for dysglycemia who might benefit from definitive diagnostic testing and interventions to prevent or treat diabetes.     

红细胞体积分布宽度与糖代谢异常/糖耐量异常和糖尿病相关

目的探讨红细胞体积分布宽度（RDW）与2型糖尿病（T2DM）、空腹血糖受损／葡萄糖耐量异常（IFG／IGT）的相互关系。方法对152例在我院定期进行健康体检或治疗的患者,依据血糖情况分为3组,其中T2DM组42例,IFG／IGT组38例,正常对照（NGT）组72例,采取空腹血,采用全自动血液分析仪测定RDW、血红蛋白,多功能血生化自动分析仪测定血总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮和空腹血糖,同时统计高血压、冠心病的发病率并分析其关系。结果RDW在T2DM组、IFG／IGT组和NGT组之间比较具有统计学差异,其中T2DM组和NGT组、IFG／IGT组比较,差异均有统计学意义（P〈0．05或P〈0．01）,IFG／IGT组与NGT组比较差异无统计学意义（P〉0．05）。多因素直线回归分析显示空腹血糖（P〈0．01）和高密度脂蛋白胆固醇（P〈0．05）是RDW的独立危险因子。结论T2DM患者RDW升高,RDW的变化与空腹血糖水平相关。     

Prevalence and trends of insulin resistance, impaired fasting glucose, and diabetes

OBJECTIVE: Our aim was to measure the prevalence and time trends of diabetes, impaired fasting glucose, and insulin resistance in the United States during the periods 1988-1994 and 1999-2002. MATERIALS AND METHODS: Data were derived from two nationally representative samples of the adult U.S. population collected as part of the National Health and Nutrition Examination Surveys of 1988-1994 (n=18,800) and 1999-2002 (n=10,283). We compared these two samples with respect to the following outcomes: previously diagnosed diabetes defined by self-report; undiagnosed diabetes defined as fasting plasma glucose > or =126 mg/dl; impaired fasting glucose defined as fasting plasma glucose 100-125 mg/dl; and insulin resistance calculated using the homeostasis model assessment as {[fasting serum insulin (microU/ml)] x [fasting plasma glucose (mmol/L)]/22.5}. RESULTS: The age- and sex-adjusted prevalence of diagnosed diabetes increased from 5.5% in 1988-1994 to 6.8% in 1999-2002 (change 1.3%, 95% confidence interval 0.5-2.1). Little change occurred in the adjusted prevalence of undiagnosed diabetes (from 3.0 to 3.0%) and impaired fasting glucose (from 26.2 to 26.9%). Mean insulin resistance and the proportion with high insulin resistance increased significantly both among normoglycemic persons (mean: from 2.0 to 2.2; proportion >2.35: from 26.2 to 32.2%) and among persons with undiagnosed diabetes or impaired fasting glucose (mean: from 4.0 to 4.5; proportion >4.4: from 24.8 to 31.1%). In 1999 to 2002, diagnosed and undiagnosed diabetes were most common in non-Hispanic blacks, whereas impaired fasting glucose was most common in Mexican Americans. CONCLUSIONS: Diabetes, impaired fasting glucose, and insulin resistance are common in the United States and their prevalence continues to increase.     

Endothelial dysfunction in impaired fasting glycemia, impaired glucose tolerance, and type 2 diabetes mellitus

The aim of this study was to evaluate whether abnormal endothelial function is present in early stages of diabetes, such as impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Endothelial function was assessed by measuring flow-mediated dilatation and nitrate-induced dilatation of the brachial artery using high-resolution ultrasound. Fasting serum lipid levels were determined, and glucose and insulin values in response to a 75-g oral glucose load were also measured. The results showed the following new findings: (1) compared with subjects with normal glucose tolerance, those with IFG and IGT had impaired flow-mediated dilatation, more remarkable in subjects with type 2 diabetes mellitus than those with IFG and IGT, and (2) flow-mediated dilatation was inversely and strongly related to the extent of hyperglycemia. In conclusion, endothelial dysfunction is present in subjects with IGT and IFG, indicating endothelial damage in these stages.