高血压患者直接进行口服葡萄糖耐量试验的临床观察

目的探讨空腹血糖7mmol/L的高血压患者,直接进行口服葡萄糖耐量试验(OGTT),早期发现糖代谢异常的价值及其安全性。方法纳入2013年6月1日至2016年7月20日于福建医科大学附属第一医院入院前1年体检空腹血糖7mmol/L且无糖尿病症状的住院患者(n=364)直接进行OGTT,收集患者血糖、血脂及一般情况等。根据是否高血压分为:非高血压组、高血压组。分析糖调节受损、糖尿病检出率,分析2组年龄、体质量指数(BMI)、血糖、血脂等差异。结果 364例患者中糖调节受损141例(38.74%),糖尿病48例(13.19%)。检查中未发生糖尿病酮症酸中毒、高渗性昏迷等需紧急降糖处理病例。与非高血压组相比,高血压组年龄更大,BMI、餐后2h血糖、糖化血红蛋白、糖调节受损和糖尿病比例更高(均P0.05)。空腹血糖5.6mmol/L高血压患者OGTT筛查餐后2h血糖(n=158),糖调节受损检出率37.3%,糖尿病检出率9.5%。有序多分类Logistic回归分析发现,与非高血压患者相比较,高血压者发生糖调节受损及糖尿病的比值比为2.286(95%CI 1.457~3.589,P0.01)。结论高血压患者常规进行OGTT,对早期发现高血压合并糖代谢异常和糖尿病具有重要的临床价值。     

非糖尿病患者急性心肌梗死早期胰岛素抵抗现象研究

目的:探讨既往无糖尿病病史的急性心肌梗死患者早期胰岛素抵抗情况.方法:2009-02至2009-09,在我院连续入选158例既往无糖尿病病史,且在发病24 h内接受急诊经皮冠状动脉介入治疗的ST段抬高急性心肌梗死患者,出院前均进行口服葡萄糖耐量试验,按照结果分为糖代谢正常组(n=44)、糖调节受损组(n=65)和新诊断糖尿病组(n=49),以稳态模型胰岛素抵抗指数(HOMA-IR)≥2.5认为存在胰岛素抵抗,评价不同糖代谢组患者急性期(入院时)与稳定期(出院时)的胰岛素抵抗情况.结果:158例患者中,胰岛素抵抗者急性期为50.0%(79/158例),稳定期为31.6%(50/158例),胰岛素抵抗比例在急性期明显多于稳定期(P=0.000),差异有统计学意义.急性期HOMA-IR(0.98±0.81)明显高于稳定期HOMA-IR(0.58±0.67),P<0.05,差异有统计学意义.急性期HOMA-IR,新诊断糖尿病组高于糖调节受损组和糖代谢正常组[(1.30±0.84)vs(0.96±0.78)vs(0.57±0.55),P均<0.05],差异均有统计学意义.稳定期HOMA-IR新诊断糖尿病组和糖调节受损组高于糖代谢正常组[(0.78±0.57)vs(0.57±0.80)vs(0.41±0.51),P均<0.05],差异有统计学意义.多元逐步回归方程显示,第2天空腹血糖[标准化回归系数(β)=0.230,P=0.000]、空腹胰岛素(β=0.758,P=0.000)、体重指数(β=0.087,P=0.005)和糖化血红蛋白(β=0.104,P=0.003)是急性期胰岛素抵抗的影响因素;体重指数(β=0.382,P=0.000)是稳定期胰岛素抵抗的影响因素.结论:无论糖代谢情况如何,胰岛素抵抗在急性心肌梗死早期有加重现象;第2天空腹血糖、糖化血红蛋白和体重指数是急性期胰岛素抵抗的影响因素,体重指数是稳定期胰岛素抵抗的影响因素.     

急性脑梗死患者糖脂代谢紊乱的临床研究

目的调查急性脑梗死患者血糖及血脂代谢异常情况,以制定合理的干预策略,改善预后。方法选择急性脑梗死患者398例,按牛津郡社区脑卒中项目分型,检测空腹血糖(FPG)、糖化血红蛋白(HbAlc)、血脂,对无糖尿病史的患者在病情稳定后,进行口服葡萄糖耐量试验(OGTT),根据FPG水平,将患者分为糖代谢正常组196例,糖调节受损组78例和糖尿病组124例,对各组糖脂水平进行对比分析。结果 398例患者总的糖代谢异常率为50.8%,其中入院后新确诊糖尿病59例(14.8%)、糖调节受损78例(19.6%),在新确诊的糖代谢异常中,40.7%的糖尿病及59.0%的糖调节受损通过OGTT确诊。与糖代谢正常组比较,糖调节受损组和糖尿病组患者血脂、FPG及HbAlc水平明显升高(P<0.05);在脑梗死各亚型中,患者FPG、血脂水平无差异,但腔隙性脑梗死患者糖代谢异常比例最高。结论脑梗死患者糖代谢异常比例高,OGTT可发现大量合并糖代谢异常患者,糖脂代谢异常在动脉粥样硬化性脑梗死的病理机制中起重要作用。     

空腹血糖未达糖尿病诊断标准患者直接进行口服葡萄糖耐量试验的异常率及安全性

目的探讨既往1年内空腹血糖检查未达糖尿病诊断标准(7 mmol/L)患者直接进行口服葡萄糖耐量试验(OGTT)糖代谢异常发生率及安全性等。方法年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病症状的患者301例直接进行OGTT,收集患者一般情况及血糖、血脂等。根据OGTT结果分为:血糖正常、糖调节受损组、糖尿病3组。分析糖调节受损、糖尿病发生率,分析3组年龄、血压、血糖、血脂等差异。结果血糖正常比例为47.18%,糖调节受损比例为34.88%,糖尿病比例为17.94%。血糖正常组年龄最小,糖尿病组高血压比例最高,糖调节受损组总胆固醇及低密度脂蛋白显著比血糖正常组高(均P0.05)。空腹血糖、餐后2 h血糖、糖化血红蛋白3组比较:血糖正常组糖尿病前期组糖尿病组(均P0.05)。空腹血糖5.6 mmol/L患者OGTT筛查餐后2 h血糖204例,其中糖耐量异常21.57%,糖尿病6.37%。3组直接行OGTT均未出现糖尿病酮症、糖尿病高渗状态等需紧急降糖处理病例,也未发现恶心、反酸、胃灼痛等消化道症状。结论年龄≥40岁、近1年体检空腹血糖7 mmol/L且无糖尿病三多一少症状的患者直接进行OGTT检查具有很强的必要性及良好的安全性。     

107例无糖尿病史急性冠脉综合征病人糖代谢异常分析

目的 观察无糖尿病史的急性冠脉综合征（ACS）住院病人糖代谢并常情况。方法 收集2006年4月-2006年9月在贵阳医学院附属医院心血管科确诊ACS的住院病人107例，排除既往有糖尿病史病人。所有病人均进行口服葡萄糖耐量试验（OGTT），以判断糖代谢情况。结果 107例无糖尿病史的ACS住院病人中糖代谢异常患病率为72．8％；其中新发现糖尿病患棚率30．8％，糖调节受损患病率为42．1％。若不进行OGTT试验，仅靠检测空腹血糖，将漏诊77．8％糖调节受损病人和66．7％的糖尿病病人。结论 既往未知糖代谢状况的ACS住院病人中可能多数（约3／4）合并糖代谢异常，并且单纯检测空腹血糖可能漏诊相当数量糖尿病前期病人和糖尿病病人．既往未知糖代谢状况的ACS病人均建议常规进行0GTT筛查。     

稳定型冠心病及合并糖尿病危险因素的高血压患者糖代谢异常筛查

目的调查在心内科门诊中既往无糖代谢异常病史的稳定型冠心病及合并糖尿病危险因素的高血压患者的糖代谢异常发生情况。方法对入选患者进行空腹或餐后毛细血管血糖检测,空腹血糖≥6.1 mmol/L或餐后随机血糖≥7.8 mmol/L的患者再进行口服葡萄糖耐量试验(OGTT)。结果共1412例患者进行毛细血管血糖检测,其中939例患者进行空腹血糖检测,281例(29.9%)患者空腹血糖≥6.1 mmol/L并且<7.0 mmol/L,105例(11.2%)患者空腹血糖≥7.0 mmol/L;473例患者进行餐后随机血糖检测,123例(26.0%)患者随机血糖≥7.8 mmol/L并且<11.1 mmol/L,43例(9.1%)患者随机血糖≥11.1 mmol/L。入选患者共552例(39.1%)毛细血管空腹血糖≥6.1 mmol/L或随机血糖≥7.8 mmol/L,其中298例患者又进行了OGTT,正常糖耐量(NGT)66例(22.1%),糖调节受损(IGR)132例(44.3%),其余100例(33.6%)患者新诊断为糖尿病。结论对既往无糖代谢异常病史的稳定型冠心病及合并糖尿病危险因素的高血压患者进行毛细血管血糖筛查及OGTT有助于早期发现糖代谢异常。     

糖化血红蛋白在高血压人群糖代谢异常诊断切点的探讨

目的探索高血压患者中,糖化血红蛋白(HbA1c)诊断糖代谢异常的切点。方法采用非随机整群抽样入选无糖代谢异常病史的高血压患者,进行横断面研究。各家医院HbA1c检测均执行卫生部临检中心质控标准。测定患者口服葡萄糖耐量试验(OGTT)空腹、OGTT 2h血糖和HbA1c水平。分别以OGTT空腹血糖≥5.6和≥7.0mmol/L作为空腹血糖受损和空腹糖尿病的标准,以OGTT 2h血糖7.8~11.1mmol/L和OGTT 2h血糖≥11.1mmol/L作为糖耐量受损和糖尿病的诊断标准。采用受试者工作特征(ROC)曲线评价HbA1c在国人高血压患者对糖尿病和糖尿病前期的诊断切点。结果本研究共入选患者687(男410、女277)例,平均年龄60.9岁。以OGTT空腹和(或)2h血糖确诊糖尿病的比例为39.0%。单纯测定空腹血糖,糖尿病的检出率仅为17.5%;将漏诊55.2%的糖尿病患者;在OGTT空腹血糖受损患者中,通过OGTT 2h血糖测定,可多检出44.6%的糖尿病患者。以HbA1c≥6.5%作为糖尿病的诊断切点时,糖尿病的检出率为32.9%。ROC曲线分析显示,HbA1c=5.8%时诊断糖尿病前期的敏感度和特异度最佳;HbA1c=6.2%时诊断糖尿病的敏感度和特异度之和最大。结论高血压患者糖代谢异常患病率高,且被大量漏诊,故对高血压患者应常规筛查糖代谢异常。建议在高血压患者HbA1c诊断糖尿病前期和糖尿病的切点分别采用5.8%和6.2%。     

新增空腹血糖受损切割点下患者OGTT结果分析

探索新增空腹血糖受损切割点下患者糖代谢状况。结果:当患者空腹血糖介于5.6～6.1mmol/L时,OGTT2h血糖正常者只有32.9%,37.3%的患者已经存在糖尿量减低,并且高达29.8%的患者已经达到糖尿病的诊断标准,也就是说空腹血糖在此范围内有高达67.1%的患者存在糖代谢异常。结论:空腹血糖受损的切点应下调至5.6mmol/L,空腹血糖大于或等于此值者应行OGTT试验。     

非ST段抬高心肌梗死病人糖耐量的动态变化

目的探讨既往无糖尿病中的非ST段抬高心肌梗死(NSTEMI)病人中糖耐量异常率及糖耐量的动态变化。方法49例既往无糖尿病的NSTEMI病人,在入院后36小时和3个月时给予口服葡萄糖耐量试验(OGTT)。结果49例NSTEMI患者中,入院时糖耐量异常(AGT)包括空腹血糖调节受损(IFG),糖耐量受损(IGT)和新诊为糖尿病)者占61%,而且大部分为IGT(约3/4)。3个月随访时,空腹血糖无改变,但是2hOGTT血糖较前降低(均数±标准差:8.5±2.7mmol/L:7.7±2.7mmol/L,P<0.05)。糖耐量得到改善,AGI患者比例降为41%。结论在既往无糖尿病史的NSTEMI病人中有着较高AGT患病率,其中大部份为IGT。后者的诊断依赖OGTT,而非空腹血糖检测。3个月后OGTT血糖水平明显较低,提示糖耐量得到改善。     

缺血性脑血管病患者糖尿病和糖调节异常的临床分析

目的研究缺血性脑血管病患者糖尿病和糖调节异常的临床意义。方法选择656例住院缺血性脑血管病患者进行空腹血糖、糖化血红蛋白等项目检测。检测后分为糖尿病组272例、糖调节异常组173例及血糖正常组211例。对既往未诊断糖尿病而空腹血糖在5.6-6.9mmol/L的患者进行口服葡萄糖耐量试验(OGTT),糖代谢分类采用2003年美国糖尿病学会建议标准。结果656例患者住院前糖尿病的诊断率为17.1%(112/656),住院后系统检查发现糖尿病患病率为41.5%(272/656),糖调节异常率为26.4%(173/656);279例空腹血糖在5.66.9mmol/L的患者中,OGTT发现其中25.4%患者可诊断为糖尿病,糖耐量异常为40.9%,3组患者空腹血糖分别为(8.5±2.4)、(5.6±0.8)及(4.5±0.7)mmol/L,糖化血红蛋白分别为(7.5±2.2)、(5.4±0.7)及(4.3±0.4)%,P均<0.01。结论缺血性脑血管病患者多合并糖尿病或糖调节异常,空腹血糖在5.66.9mmol/L的患者应常规作OGTT检查,以筛查糖代谢异常的患者。     

老年高血压病患者中2型糖尿病的诊断

目的：探讨老年高血压病患者中２型糖尿病（ＤＭ２）的发病情况及诊断,方法对１６８例老年高血压病患者进行空腹血糖检查和标准口服葡萄糖耐量试验,比较２型糖尿病筛查方法及相关因素。结果（１）１６８例老年高血压病患者中４６例伴有２型糖尿病,未诊断率为２７．３８％。（２）ＦＰＧ≥７．８ｍｍｏｌ／Ｌ时敏感性和特异性分别为６７．３９％和９９．１２％;ＦＰＧ≥７．０ｍｍｏｌ／ＬＪＦ ＴＸＤＧ２ＮＴＧ Ｔ ＴＲＦ Ｎ     

血糖正常的高血压患者做葡萄糖耐量试验的临床意义

目的：探讨对空腹血糖正常的高血压患者进行葡萄糖耐量试验（OGTT）的意义。方法：选择既往无糖代谢异常病史，空腹血糖〈5．6mmol／L，确诊原发性高血压的成人患者；行OGTT2h血糖测定，如果OGTT2h血糖≥11．1mmol／L，再次行OGTT以排除糖尿病。同时观察年龄，入院时血压、体重指数、血肌酐、血尿酸、甘油三酯、高密度脂蛋白等参数的改变。结果：本组266例患者中检出糖耐量减低者（OGTT2h血糖≥7．8mmol／L）共98例（36．8％），其中确诊2型糖尿病29例（OGTT2h血糖≥11．1mmol／L），占10．9％。结论：所有空腹血糖正常的高血压患者均应进行OGTT，以发现可能的糖代谢异常，使患者能得到早期干预，更显著地降低心血管事件发生的风险。     

Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance?

AIMS: To investigate whether admission hyperglycaemia in non-diabetic patients with acute myocardial infarction (AMI) is a surrogate for previously undiagnosed abnormal glucose tolerance. METHODS AND RESULTS: Two hundred non-diabetic patients with AMI were divided into three groups: 81 patients with admission glucose < 7.8 mmol/L (group 1), 83 patients with admission glucose > or = 7.8 mmol/L and < 11.1 mmol/L (group 2), and 36 patients with admission glucose > or = 11.1 mmol/L (group 3). Abnormal glucose tolerance, diabetes, or impaired glucose tolerance (IGT) was diagnosed by oral glucose tolerance test (OGTT). OGTT identified diabetes in 53 patients (27%) and IGT in 78 patients (39%). When the fasting glucose criteria were applied, however, only 14 patients (7%) were diagnosed as having diabetes. The prevalence of abnormal glucose tolerance was similar among the three groups: 67% in group 1, 63% in group 2, and 69% in group 3 (P = 0.74). The relation of fasting glucose (r2 = 0.50, P < 0.001) and HbA1c (r2 = 0.34, P < 0.001) to 2-h post-load glucose was significant, but the relation of admission glucose to 2-h post-load glucose was not significant (r2 = 0.02, P = 0.08). Multivariable analysis showed that fasting glucose and HbA1c were independent predictors of abnormal glucose tolerance, but admission glucose was not. CONCLUSION: Admission hyperglycaemia in non-diabetic patients with AMI does not represent previously undiagnosed abnormal glucose tolerance. Fasting glucose and HbA1c, rather than admission glucose, may be useful to predict abnormal glucose tolerance. However, these parameters lacked sensitivity. OGTT should be considered in all non-diabetic patients with AMI.     

中国住院冠心病患者糖代谢异常研究--中国心脏调查

目的 探讨中国冠心病患者糖代谢异常的流行状况。方法 选取北京、上海等7个城市共52家三级甲等医院为合作研究中心，于2005年6月1日至2005年9月31日在各医院心内科所有符合冠心病诊断纳入标准的住院患者连续入选为研究对象，共收集有效病例3513例。未确诊为糖尿病的对象均需进行口服葡萄糖耐量试验（OGTT），以判断糖代谢状况。结果 冠心病住院患者中糖尿病患病率为52．9％，糖调节受损患病率为24．0％，总的糖代谢异常患病率为76．9％。若不进行OGTT试验，仅依靠检测空腹血糖，将有87．4％糖调节异常患者和80．5％糖尿病患者被漏诊。结论 中国冠心病住院患者中绝大多数合并糖代谢异常，并且需要通过OGTT及时准确地发现这些合并糖代谢异常的患者。     

Hypolipidemic effects of metformin in hyperprebetalipoproteinemia.

Metformin's hypolipidemic effects (2.55 g/day for 3 months) have been studied in 19 subjects with Fredrickson's Type IV hyperprebetalipoproteinemia. The majority of patients were above ideal body weight (relative body weight = 118 +/- 2.7 %). Eleven of the subjects presented chemical diabetes, 5 fasting hyperglycemia, and 3 normal glucose tolerance. After treatment with metformin, body weight showed a slight, but significant reduction (--2.4 +/- 0.3 kg). Glucose tolerence was not substantially altered while basal glucose was significantly reduced in the 5 subjects with fasting hyperglycemia. Basal plasma insulin was significantly reduced in all the patients following metformin treatment. Insulin response to OGTT was slightly reduced in the subjects with fasting hyperglycemia. Independent of the patients' glucose tolerance, metformin treatment induced a marked decrease in plasma triglycerides (-- 40 %) and a reduction in plasma cholesterol (-- 12 %). No correlation was found between triglyceride and cholesterol reduction and body weight, glucose, and plasma insulin variations. Like phenformin, metformin acts not only on glucose metabolism and insulin secretion but on lipid metabolism as well.     

Beta-blockers use and risk of hyperglycemia in acute stroke patients

BackgroundBeta-adrenergic blockade prevents or diminishes stress-induced hyperglycemia in different experimental models. The aim of the study was to determine if the use of beta-blockers before stroke reduces the risk of acute hyperglycemia in stroke patients.MethodsWe analyzed the data of 603 consecutive patients with acute ischemic stroke and without pre-stroke diagnosis of diabetes mellitus admitted to stroke unit within 24 h after symptoms onset.ResultsPlasma glucose level on admission (6.0 ± 1.4 vs 6.6 ± 1.9 mmol/L, P = 0.01) and fasting glucose on day 1 (5.2 ± 1.1 vs 5.7 ± 1.1 mmol/L, P = 0.02) were significantly lower in patients treated with beta-blockers before stroke than in those who did not receive such a treatment. On multivariate logistic analysis beta-blockers use before stroke was associated with reduced risk of glucose level on admission ≥7.8 mmol/L (OR: 0.22, 95%CI: 0.07–0.74) and fasting glucose on day 1 ≥ 7.0 mmol/L (OR: 0.21, 95%CI: 0.05–0.91). The risk of fasting hyperglycemia defined as glucose ≥6.1 mmol/L did not differ between groups.ConclusionsBeta-blockage before stroke onset may result in lower plasma glucose on admission and prevent early hyperglycemia in patients without pre-stroke diagnosis of diabetes mellitus.     

Insulin secretion and insulin sensitivity in Japanese subjects with impaired fasting glucose and isolated fasting hyperglycemia

Impaired fasting glucose (IFG) is a subgroup of impaired glucose regulation exhibiting an elevated fasting glucose levels without elevated 2-h glucose levels on oral glucose tolerance test (OGTT). Diabetes mellitus with isolated fasting hyperglycemia (DM/IFH) is a similar subgroup of diabetes having higher fasting glucose levels with 2-h glucose levels within the non-diabetic range. The aim of this study is to profile the characteristics of these subgroups to estimate the factors involved in the development from normal glucose tolerance (NGT) via IFG to DM/IFH. Five hundred and sixty seven Japanese males were classified on the basis of 75 g OGTT into four groups, NGT, IFG, DM/IFH, and isolated impaired glucose tolerance (isolated IGT). Insulin secretion was evaluated by insulinogenic index, insulin sensitivity was evaluated by ISI composite, and insulin secretory patterns were compared additionally. IFG and DM/IFH subjects exhibited both lower insulin secretion and lower insulin sensitivity than NGT subjects. There was an insulin peak in NGT, IFG, and DM/IFH at 60 min, which did not occur in isolated IGT. Impaired early-phase and basal insulin secretion and decreased insulin sensitivity both are estimated as factors in progression from NGT via IFG to DM/IFH in these subjects. IFG and DM/IFH subjects have definite fasting hyperglycemia in contrast to isolated IGT subjects, 2-h glucose levels being maintained within the non-diabetic range partly by the insulin peak at 60 min.     

Relevance of casual undetected hyperglycemia among high-risk individuals for developing diabetes

To assess the relevance of unrecognized hyperglycemia among high-risk subjects for developing diabetes a cross-sectional study was carried out. Subjects aged 40-75 years with (high-risk group) and without (control group) history of impaired glucose metabolism underwent a 2h-oral glucose tolerance test (OGTT). All individuals with diabetes diagnostic criteria and all controls with glucose abnormalities at OGTT were excluded. An individualized 48-h continuous glucose monitoring (CGM) calibrated by fasting plasma glucose was performed. The microdialysis-based biosensor recordings were computerized in order to identify continuous glucose profiles. Of the 121 monitored subjects, 104 were finally analyzed (56.7% female, 57.8 years, BMI=29.2, A1C=4.9%, HOMA index=2.5). Glucose profiles corresponded to 31 controls (29.8%), 32 high-risk individuals with normal OGTT (30.8%) and 41 (39.4%) with hyperglycemia at OGTT. The recordings defined as hyperglycemia (fasting >or=6.1 mmol/l, non-fasting >or=7.8 mmol/l) appeared during an average of 1.4h, 4.9h and 7.6h (3.9%, 13.9% and 19% of the CGM time), respectively. The highest percentage of impaired CGM registers corresponded to the fasting period. Nevertheless, the longest duration corresponded to the non-fasting period. The CGM evidenced a relevant degree of casual undetected hyperglycaemia among high-risk individuals.     

Marginal association of fasting blood glucose with the risk of cystic fibrosis-related diabetes

ObjectivesCystic fibrosis-related diabetes (CFRD) may be diagnosed by fasting blood glucose ≥ 7.0 mmol/L and/or glucose ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). We compared the role of fasting and stimulated glucose for diagnosis of CFRD.MethodsWe performed a cross-sectional review of the prevalence of fasting glycemic abnormalities and Kaplan-Meier survival analysis of risk of progression to CFRD according to baseline fasting glucose in the prospective Montreal Cystic Fibrosis Cohort.ResultsIsolated fasting hyperglycemia was detected in only 8% of participants at study onset. Eighty percent of subjects had isolated post-challenge hyperglycemia on their first OGTT meeting criteria for CFRD. Kaplan Meier survival analysis demonstrated that impaired fasting glucose (IFG) alone is not a risk factor for CFRD. Subjects with combined IFG and impaired glucose tolerance at baseline (IGT) had the highest risk of progression to CFRD.ConclusionPost-prandial elevations in blood glucose are more common at diagnosis of CFRD. While IGT is a significant risk factor for CFRD, IFG alone is uncommon and does not increase the risk of CFRD. Patients with both IGT and IFG have the highest risk of CFRD.