上钢社区部分居民血糖异常情况的调查与分析

目的通过对社区482例社区居民的现况调查,了解上钢社区糖尿病患病情况,从而有针对性地开展预防和干预。方法随机选择上钢社区2个居委,按5％的比例随机抽取20岁以上的居民482人,通过糖尿病现况问卷调查,统计分析现在糖尿病患者的基本情况。结果上钢社区的糖尿病患病率为17．84％,IGT患病率为7．8％。40岁以上人群是体质指数超标和血糖异常的主要患者。结论应当加强社区40岁以上人群的糖尿病筛查工作,特别是餐后血糖的筛查。     

老年人群糖尿病和IGT患病率及其影响因素

目的：了解重庆市老年人群糖尿病（DM）和糖耐量低减（IGT）的患病情况及其主要患病风险因素，为城市社区人群制定适宜的预防和干预措施提供科学依据。方法：采用整群分层抽样方法，对60岁以上1791例自然人群进行了横断面调查。结果：DM患病率14．45％，IGT患病率21．70％，随着年龄增加，DM和IGT患病率亦逐渐升高。超重者（BMI≥25）DM和IGT患病率为17．51％和28．02％，肥胖者（BMI≥30）DM和IGT患病率为21．43％和37．14％，按腰臀比（WHR）划分，向心性肥胖者DM和IGT患病率为17．45％和25．09％。影响DM患病风险的因素主要有：DM家族史、BMI、wHR、高收缩压、高甘油三酯。结论：在社区人群中，倡导健康合理的膳食习惯、控制血压、体重是降低糖尿病发生的重要措施，老年人是DM防治工作的主要对象。     

2型糖尿病患者及高危人群社区综合干预效果分析

目的评价综合干预对社区2型糖尿病患者和高危人群的控制效果，为社区慢性病干预提供建议。方法对东城区小黄庄社区的102例糖尿病患者和88名高危人群进行综合干预，包括：健康教育，定期体检，饮食，运动和心理等综合干预，对干预前后结果运用SPSS 11．5软件包进行统计分析，t检验。结果干预前、后相关知识，参与运动的人数均有显著改善，血压、血糖各项指标差异也有统计学意义。结论社区综合干预对糖尿病患者和高危人群有较好的控制效果，社区卫生站应该开展积极、有效的综合干预。     

社区糖耐量减低人群护理干预研究

目的观察社区护理干预措施对糖耐量减退(IGT)人群的转归和不良行为的转化,探讨糖尿病防治新模式。方法对顺德某社区居民进行血糖检测,筛选出100例IGT者,并随机分为干预组和对照组,每组50例,对干预组进行为期3年的社区干预,比较两组人群在干预前、后的行为的转化及疾病的转归。结果3年社区干预后,干预组在干预前、后不良行为的转化率均较对照组明显升高。转归与对照组相比,差异均具有统计学意义。结论对IGT人群采取长期综合社区干预措施可明显降低糖尿病高危因素指标,并改善其转归。     

社区居民糖尿病前期患病率分析

目的调查天津市劝业场社区居民糖尿病及糖尿病前期的患病率。方法选择天津市劝业场社区年龄在20岁以上的重点人群作为调查对象,给予实验室检测和问卷调查,观察糖尿病前期患者的患病率及其与年龄、体质指数（BMI）的关系。结果被调查的1379名居民中,符合糖耐量受损（IcR）诊断标准者175人,患病率为12．7％,其中糖调节受损（IGT）155人,患病率8．33％;空腹血糖受损（[rc）38人,患病率为2．75％;IFGklGT22人,患病率1．59％。符合糖尿病诊断标准112人,患病率为8．12％,其中原有糖尿病78人,新发现糖尿病34人。患病率随着年龄的增高有上升的趋势。IFG患病率、IGT患病率及IFG＼IGT患病率均在40～49岁年龄组最高,分别为2．89％、13．50％、3．53％。不同年龄组患病率与BMI呈正相关。结论糖尿病前期患者的患病率随着年龄、BMI增长而增高,对重点人群进行糖尿病前期筛查,以便及早干预,对社区开展糖尿病综合防治工作具有积极意义。     

促进糖尿病社区康复的护理体会

目的：观察健康教育干预对糖尿病社区康复的作用,探讨糖尿病防治新模式。方法：通过健康体检筛选出符合糖尿病前期标准的人群并随机分为对照组和干预组每组50例对干预组人群50例。对干预组糖尿病患者开展了糖尿病社区护理干预。结果：调查问卷结果显示干预后DM前期人群的相关知识知晓率、经常锻炼率较干预前均有明显提高,且差异有统计学意义（P〈0．05）。而体重控制率差异无显著性。另外,对干预前后生化指标进行比较分析发现,干预后与干预前比较DM前期人群的空腹血糖、餐后2小时血糖、甘油三酯及总胆固醇等均有所明显下降,且差异有统计学意义（P〈0．05）。结论：对DM患者进行社区干预,可明显提高DM前期人群的知识知晓率、经常锻炼率、血糖控制率及血脂控制率,可有效减缓IGT和IGF向DM的转变,降低各种DM高危因素指标,有望减少DM的发病率和慢性并发症的发生率。延长DM患者的生命,提高生活质量。     

体质指数、腰臀比和糖尿病的调查研究

目的研究糖尿病与肥胖的关系。方法采用整群抽样方法，调查在深圳居住年限超过5午（含5午）、20岁以上的8200名常住居民。结果在所调查的对象中体质指数（BMI）≥25（肥胖），其糖尿病的发病率和糖耐量（IGT）为2．6，高出BMI〉25（不肥胖）组2．3倍；腰臀比（WHR）≥1组的糖尿病的发病率和糖耐量（IGT）为5，是WHR〈1组的2．5倍。当腰围增加1cm，患DM和IGT的比率相应地增加0．5％和1％。结论肥胖是引发糖尿病的一个重要因素，应该在此类人群中采取有效的干预性措施来预防糖尿病的发生。     

成人糖尿病和糖耐量低减经济负担的病例对照研究

目的：初步估算首钢3个下属企业糖尿病经济负担，以推动糖尿病成本测算工作的进一步开展。方法：以三厂在1992年首都钢铁集团公司糖尿病普查所发现的95例糖尿病患者和77例糖耐量低减（IGT）患者的2个病例组：根据整群随机抽样法，选择三厂1878例非糖尿病、非IGT人群为本次研究的对照组。结果：糖尿病、IGT经济负担分别是对照组的2．69倍和1．25倍。糖尿病、IGT、对照组直接费用与间接费用之比分别为9．34、4．64、 9．38。两病例组年人均总费用不存在性别差异，但均随着年龄增加而上升。结论：糖尿病和IGT患者的经济负担高于一般人群，其中绝大部分是直接费用。     

友谊路社区老年人糖尿病筛查结果分析

目的通过对社区60岁以上老年人糖尿病的筛查,探讨糖尿病早期预防和控制策略。方法采用天津市城市老年人糖尿病筛查表,对社区60岁以上老年人进行糖尿病的筛查,并进行早期干预和临床分析。结果在社区60岁以上老年人糖尿病的筛查中,糖尿病（DM）、糖耐量低减（IGT）及空腹血糖损害（IFG）的检出率分别为17.58%,1%和0.82%。与检出率相关的因素有：年龄、体重指数（BMI）、血压、血脂和家族史,显示社区老年人糖尿病患者中存在大量无症状的DM、IGT、IFG人群。结论在社区开展老年糖尿病筛查,对高危人群开展广泛的糖尿病教育和防治,早期发现DM、IGT和IFG,把糖尿病的危害控制在最低限度是一项重要工作。     

二甲双胍对糖耐量减低患者的干预治疗研究

目的观察二甲双胍对糖耐量减低(IGT)人群转变成2型糖尿病转化率的作用以及对IGT逆转为正常糖耐量的作用。方法以口服葡萄糖(OGTY)试验，按1999年WHO标准确诊的IGT 254例被随机分为两组，治疗组及对照组，每组127名，两组受试者的基本情况具有可比性。对照组按照中国营养学会制订的《中国居民膳食指南》中的饮食原则合理膳食，并适当增加体力活动；治疗组除给予相同内容的健康教育外，同时给予患者口服二甲双胍片，每日2次，每次0．5g。试验治疗期为2年。采用前瞻性对列研究的分析方法，计算治疗组和对照组的糖尿病累计发病率，并估计相对危险度。结果治疗2年后，34名IGT转变为糖尿病，其中治疗组和对照组分别为9例和25例，治疗组的糖尿病累积发病率为7．8％，对照组的糖尿病累积发病率为21．4％(P=0．004)，相对危险度RR为0．366(95％可信区间0．179—0．750)，治疗组和对照组逆转IGT到正常糖耐量的比例分别为56％和32．9％。结论采用二甲双胍干预治疗IGT是预防和延缓IGT向2型糖尿病发展的高效措施。     

118例糖耐量低减者的追踪观察

目的：探讨影响IGT（糖耐量低减）者转归的重要因素。方法：以普查出的IGT者作为研究,追踪观察5年后,复查血糖,将获得的资料作非条件logistic回归分析。结果：对118例IGT者经5年追踪观察,共随访到85例,其中DM（糖尿病病人）的年龄转换率为3．5％,转为NGT（正常者）的年龄转换率为23．5％,研究表明年龄（OR＝1．070,P＜0．05）,首次空腹血糖（OR＝2．213,P＜0．05）在IGT者转归中起着重要作用。结论：首次空腹血糖水平可作为预测IGT转归的指标。     

Effect of interferon therapy on carbohydrate metabolism in chronic hepatitis C patients]

Reversible impact of alpha-interferon on carbohydrate (CH) metabolism was observed in patients with hepatitis C treated with interferon between 1993 and 1997. Of the 32 patients 3 individuals had known to have diabetes mellitus before the treatment and 1 had impaired glucose tolerance (IGT). 28 patients proved to have normal CH metabolism before the interferon treatment. To each patients was interferon alpha was administrated in a dose 3 MU TIW. During the 6 months interferon therapy of the 3 patients treated with oral antidiabetic drug one's diabetes mellitus did not deteriorated, but 2 patients required insulin therapy. In the patient with known IGT a manifested diabetes mellitus has gradually developed. Out of the 28 patients with normal CH metabolism in 9 cases developed IGT, 19 patient's CH metabolism did not change significantly. All of the changes induced by interferon proved to be reversible.     

60例糖尿病前期患者综合干预管理效果观察

[目的]分析对糖尿病前期患者进行综合干预管理的效果。[方法]对某大型企业在职职工1 817人,使用葡萄糖氧化酶法检测空腹和餐后2 h静脉血浆血糖。对检出的60例糖尿病前期患者进行综合干预管理2年。[结果]干预管理后糖尿病知识知晓率、血压控制率、经常锻炼率较干预前有明显提高,差异有统计学意义,空腹血糖较干预前下降。60例中有14例发生糖尿病,其中单纯空腹血糖受损(IFG)年转变率为3.8%,单纯糖耐量减低(IGT)为10.5%,空腹血糖受损兼有糖耐量减低(IFG/IGT)为27.8%。IFG与IGT糖尿病年转变率差异无统计学意义;IFG/IGT糖尿病年转变率高于IFG,差异有统计学意义;IGT与IFG/IGT糖尿病年转变率差异无统计学意义。[结论]对IFG、IGT及IFG/IGT者均应给予积极的干预,特别是对IFG/IGT者,从而降低糖尿病的发病率。     

对妊娠期糖耐量受损妇女胰岛素抵抗和胰岛素生成的观察

目的:通过糖耐量实验后(OGTT)3h胰岛素反应,探讨妊娠期糖耐量受损(IGT)和妊娠期糖尿病(GDM)妇女的胰岛素水平和胰岛素抵抗。方法:选择24～28周孕妇75例进行OGTT试验。正常妊娠组30例(Ⅰ组),IGT组26例(Ⅱ组),GDM组25例(Ⅲ组)。应用胰岛素生成指数和平均胰岛素浓度反映胰岛素分泌水平,应用空腹胰岛素浓度和稳态模式HOMA-IR反映胰岛素抵抗。结果:正常妊娠组(NP)空腹胰岛素水平显著低于GDM组和IGT组(P<0.001和P<0.005)。GDM组胰岛素分泌指数显著低于NP组(P<0.05),在GDM组和IGT组之间,稳态模式HOMA-IR和早期胰岛素生成指数(IGT)无显著差异(P>0.05),总的胰岛素分泌在GDM组最高,其次IGT组,与NP组有显著差异(P<0.001和P<0.005)。结论:妊娠期糖尿病和糖耐量受损病人之间有显著相似之处,IGT妇女的空腹胰岛素和胰岛素抵抗指数与GDM无显著差异。由此得出,糖耐量减低应被视作病理状态,应该与GDM病人一样对待。     

Impaired glucose regulation in adults in Jamaica: who should have the oral glucose tolerance test?

OBJECTIVE: To compare the 1999 World Health Organization (WHO) fasting plasma glucose (FPG) criteria and the WHO 2-hour post-challenge glucose (2hPG) criteria during an oral glucose tolerance test (OGTT) in identifying adults in Jamaica with hyperglycemia. As the OGTT is not commonly used in clinical practice, factors associated with the failure of the FPG criteria to detect persons with impaired 2hPG were investigated. METHODS: A random sample of 2 096 adults, 25-74 years old, living in the town of Spanish Town, Jamaica, was evaluated for diabetes. After excluding 215 individuals for reasons such as missing data, the remaining 1 881 persons were composed of 187 who were previously known to have diabetes and 1 694 who were screened for diabetes with both FPG and 2hPG. RESULTS: The FPG criteria detected 83 cases of diabetes, compared to 72 by the 2hPG criteria. The kappa statistic comparing the two criteria was 0.31 (95% confidence interval: 0.28-0.34), indicating fair agreement. There were 261 cases of impaired glucose tolerance (IGT) and 92 cases of impaired fasting glucose (IFG). In those 92 with IFG, an OGTT would identify 34 cases of IGT and 14 cases of diabetes. Of those classified as normoglycemic by FPG criteria, 14% of them had IGT or diabetes by 2hPG criteria. The factors predicting the likelihood of non-detection of impaired glucose tolerance or diabetes by FPG were age, body mass index, central obesity, systolic blood pressure, and female sex. By receiver operating characteristic curve analysis, an FPG of 5.1 mmol/L would predict a 2hPG >/= 7.8 mmol/L. CONCLUSIONS: A few individuals classified as normal on FPG will have IGT or diabetes, and an OGTT will be needed to identify them. The yield of IGT detected by screening in Jamaica can be improved by lowering the threshold for IFG or by using clinical information to identify high-risk individuals.     

Assessment of Risk Factors for Development of Type-II Diabetes Mellitus Among Working Women in Berhampur, Orissa

Objectives:

1) Assess general health condition and anthropological parameters of the working women. 2) Identify prevalence of Type-II Diabetes among them. 3) Assess risk factors associated with development of diabetes. 4) Educate them about Life Style Modifications.

Materials and Methods:

A cross sectional study was carried out in six educational institutes. A total of 100 working women were selected as study population. During the two-month study period, Fasting Blood Sugar (FBS) was estimated to identify the diabetics and the Impaired Glucose Tolerance (IGT). Information from the study population was collected through pre-tested questionnaire using several anthropometric measurements.

Results:

Out of 100 women, 24 were having FBS compatible with IGT or diabetes. The incidence was highest in 46 to 55 yr age group. 75% of women with diabetes or IGT were in higher income group. Body Mass Index was more than 25 kg/m² in maximum (75%) women having diabetes or IGT. 92% women with diabetes or IGT had their Waist Hip Ratio ≥0.85. Moreover, orientation towards healthy life style modification to control diabetes and its prevention was poor among the study population.

Conclusion:

Prevalence of diabetes and IGT was higher among urban working women and is increasing with increase in age. Obesity plays a major role in development of Type 2 diabetes. Several long- and short-term steps should be taken for promotion of healthy life style modifications to prevent diabetes and emergence of its complications.     

Evaluation of a diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for mild type 2 diabetes and IGT

The purpose of this study was to evaluate the efficacy and feasibility of a newly developed diabetes patient education program consisting of a three-day hospitalization and a six-month follow-up by telephone counseling for patients with mild type 2 diabetes or impaired glucose tolerance (IGT) by a randomized controlled trial (RCT) method. Fifty-two patients with mild type 2 diabetes or IGT (HbAlc<8) were randomly assigned to either an intervention group or a control group. The current care was continued for the control group and the new education program was provided in addition to the current care for the intervention group. Changes in weight, blood glucose in a 75g-oral glucose tolerance test (75g-OGTT), and HbAlc were measured in June 1997 as baseline data and again in Dec. 1997. Scores for knowledge of diabetes, dietary habits, physical activity, health practice index, diabetes quality of life (DQOL), and self-efficacy were also obtained. After six months, the intervention group showed a statistically significant weight loss and blood glucose reduction in the 75g-OGTT test, but the control group did not. A significant improvement in lifestyle was observed in the intervention group, especially in terms of dietary habits and physical activity. The knowledge test scores increased in both groups. There were no significant differences in HbAlc, DQOL, or self-efficacy between the two groups. The results of this study show that the combination of a three-day hospitalization and a six-month follow-up by telephone counseling is effective in metabolic control and improvement of lifestyle for patients with mild type 2 diabetes or IGT. The reasons for the effectiveness were considered to be that l)changes in lifestyle were based on autonomous decision-making; 2)regular, consistent counseling was provided by the nurse in charge of each patient; 3)extended follow-up is more effective than initial education in preventing a rebound of weight or metabolic control.     

Cardiovascular disease risk factors and glucose tolerance. The Wadena City Health Study.

Cardiovascular risk factors were examined in 453 subjects participating in the Wadena City Health Study, a population-based study to assess the relationship between diabetes and glucose intolerance with age. Each subject was classified as either having non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), or normoglycemia, using WHO criteria. Age- and body-mass-adjusted levels of systolic and diastolic blood pressure were lowest for those with normoglycemia, intermediate for those with IGT, and highest for those with NIDDM. Age- and body-mass-adjusted levels of high-density lipoprotein cholesterol were lowest for those with NIDDM, intermediate for those with IGT, and highest for those with normoglycemia, while triglyceride levels were highest for those with NIDDM, intermediate for those with IGT, and lowest for those with normoglycemia in women but not in men. Low-density lipoprotein cholesterol levels were lowest for those with NIDDM, intermediate for those with IGT, and highest for those with normoglycemia. With the exception of men with IGT, no differences by glycemic strata were observed for plasma total cholesterol. The prevalence of smoking showed no consistent pattern by glycemic status. These findings suggest that individuals with IGT have an atherogenic risk factor pattern that may put them at greater risk for coronary heart disease than those with normoglycemia. Intervention strategies such as diet, exercise, and/or drug therapy should be tested to evaluate whether these are effective in preventing conversion to overt diabetes and normalizing cardiovascular disease risk factors.     

二甲双胍对IGT的干预治疗疗效观察

近年来糖尿病（ＤＭ）和糖耐量减低（ＩＧＴ）患病率有逐年增高的趋势,研究发现几乎所有的ＤＭ患者在发生ＤＭ之前,均经过ＩＧＴ阶段。本文通过对３２例ＩＧＴ者随机分为二甲双胍治疗组及非药物干预治疗组比较分析,结果提示,二甲双胍治疗组比非药物干预治疗组ＤＭ发生率明显减少,而ＩＧＴ向糖耐量正常（ＮＧＴ）人转化者则明显增多,这可能是二甲双胍具有不刺激胰岛β细胞分泌胰岛素,且能预防和减轻胰岛素抵抗,减轻高胰岛素血症之特点,进而能针对ＩＧＴ的基本缺陷——胰岛素抵抗和胰岛素分泌异常进行干预治疗,结果可纠正ＩＧＴ患者的糖代谢紊乱,防止ＩＧＴ向ＤＭ转化,同时又能使ＩＧＴ向糖耐量正常（ＮＧＴ）人转化。因此,用二甲双胍对ＩＧＴ的干预治疗对提高ＩＧＴ人群的生活质量,减少ＤＭ的发病率具有重要的意义。