体格测量对围绝经期糖尿病患病风险的预测

目的：探讨围绝经期女性人体测量参数对2型糖尿病( T2DM)患病风险的预测价值。方法以2011年1月至2014年12月在广州市妇女儿童医疗中心体检中心参与体检并符合纳入标准的637例围绝经期女性为研究对象,进行T2DM患病筛查,测量身高、体重、腰围( WC )、臀围,计算体质指数( BMI )、腰臀比( WHR )和腰围身高比( WHtR );采用Logistic回归和ROC曲线评估各指标对T2DM患病风险的预测价值。结果有20.3%的调查对象患T2DM;随着BMI(χ2=9.64,P=0.008)、WC(χ2=8.99,P=0.010)、WHR(χ2=18.78,P<0.001)和WHtR(χ2=10.97,P<0.001)反映肥胖程度的增加,T2DM患病率上升,差异均有统计学意义。在控制年龄差异之后的多因素Logistic回归分析结果显示,仅BMI≥28kg/m2( OR=2.61,95%CI：1.22~5.56)和WHR≥0.85(OR=2.35,95%CI：1.43~3.88)与T2DM的发生相关。 ROC测定结果显示,4项指标单独用于预测血糖异常状况的效果均不理想,WHR和WHtR相对较好,ROC曲线下面积(AUC)分别为0.67和0.64,BMI最差,为0.60。结论腹型肥胖指标WHR和WHtR对围绝经期女性T2DM的预测价值优于BMI和WC,其为该时期女性T2DM高危人群的筛查提供了合适的参数。     

Waist-to-hip ratio is a better anthropometric index than body mass index for predicting the risk of type 2 diabetes in Taiwanese population

Body mass index (BMI) has been reported to be related to the risk of type 2 diabetes and hypertension. However, waist circumference or waist-to-hip ratio (WHR) can better reflect the accumulation of intra-abdominal fat and might be a better predictor than BMI of the risk of type 2 diabetes and hypertension. We hypothesized that other anthropometric indices rather than BMI could more accurately predict the risk of type 2 diabetes and hypertension. The purpose of this study was to determine which anthropometric index can be a better predictor for forecasting the risk of type 2 diabetes and hypertension in the Taiwanese population. We conducted a cross-sectional study and reviewed data derived from the Nutrition and Health Survey in Taiwan, 1993-1996. The subjects were 2545 men and 2562 women, aged 18 to 96 years. Receiver operating characteristic curve analysis was used to measure the predictive diabetic and hypertensive performance of each anthropometric measurement based on the area under the curve (AUC). Among 5 anthropometric indices, WHR had a significantly adjusted odds ratio (OR) and the highest AUC (0.72 for men and 0.80 for women) to predict the risk of type 2 diabetes. Although BMI had a significantly adjusted OR, the AUC was not the highest among the 5 anthropometric indices used to predict the risk of hypertension. Our findings suggested that WHR is a better anthropometric index for predicting the risk of type 2 diabetes, and the optimal cutoff values of WHR are considered as 0.89 for men and 0.82 for women in the Taiwanese population.     

代谢综合征组分对2型糖尿病的预测作用及调控意义

目的探讨社区居民糖尿病患病情况及代谢综合征组分对2型糖尿病的预测作用与调控意义。方法采用分层整群抽样方法对徐州市社区20岁以上成人糖尿病及代谢综合征的患病情况进行研究,SPSS16.0软件进行统计分析。结果社区人群糖尿病、代谢综合征患病率分别为4.4%、10.3%,代谢综合征中糖尿病患病率高于一般人群(P﹤0.05)。排除血糖后,代谢综合征单组分中体质指数(OR=1.692,95%CI 1.139～2.515),血压(OR=4.152,95%CI 2.814～6.126)是糖尿病的独立预测因子。代谢综合征多组分组合中体质指数合并高血压和高甘油三酯组(OR=3.218,95%CI 2.037～5.082,P﹤0.01)对糖尿病的预测作用最强。结论代谢综合征单组分体质指数和高血压是2型糖尿病的独立预测因素,体质指数合并高血压和高甘油三酯聚合体对2型糖尿病有较强预测作用。对代谢综合征组分的综合调控可能对糖尿病及心脑血管疾病的预防具有公共卫生意义。     

健康教育对2型糖尿病患者代谢性指标控制和生命质量的影响

目的观察健康教育对2型糖尿病患者病情控制和生命质量的影响。方法对2型糖尿病患者进行健康教育3个月,并在此前后进行糖尿病控制状况量表(CSSD70)、糖尿病生命质量量表(A-DQOL)调查,并分别检测空腹血糖、餐后2小时血糖、糖化血红蛋白、尿微量白蛋白、血浆总胆固醇、甘油三酯及体重指数。结果健康教育3个月后,患者的糖尿病控制状况评价、生活质量评分及各项代谢指标均显著改善。结论健康教育对改善糖尿病患者的疾病控制、生命质量、糖代谢情况起着确切的积极作用。     

BMI、WC和腰臀比与2型糖尿病患者死亡风险的队列研究

目的  了解淮安市2型糖尿病(diabetes mellitus type 2,T2DM)患者不同肥胖指标对其死亡风险的影响。方法  将淮安市2013年1月1日―2020年12月31日队列随访的9 759例T2DM患者与死因监测平台进行匹配,确定死亡病例。根据BMI、WC、腰臀比(waist-to-hip ratio,WHR)对随访人群进行分组,采用Cox比例风险模型探究肥胖指标对于T2DM患者全死因死亡风险。随后采用敏感性分析,剔除吸烟人群、随访第1年死亡者、基线患心脑血管病者后分析全死因死亡风险情况。结果  不同年龄、WC、WHR及其他指标的人群BMI差异均有统计学意义(均有P＜0.05)。且调整混杂因素后发现,在超重和肥胖人群与正常人群相比死亡风险分别下降17%和27%,差异均有统计学意义(均有P＜0.05)。患者WC与非中心性肥胖相比,中心性肥胖前期和中心性肥胖时期均可以降低死亡风险,不同WHR人群死亡风险差异无统计学意义。结论  目前死亡风险存在“肥胖悖论”现象,研究发现超重和肥胖人群以及中心性肥胖前期死亡风险具有保护作用。     

2型糖尿病与恶性肿瘤发病风险关系的队列研究

目的 探讨2型糖尿病与恶性肿瘤发病风险之间的关系。方法 利用浙江省慢性病监测信息管理系统收集2007－2013年监测队列中糖尿病、恶性肿瘤患者及相关信息,采用累积发病率、RR值及其95%CI等指标分析2型糖尿病与恶性肿瘤间的关系。结果 2007－2013年共收集327 268例2型糖尿病患者并随访778 439人年,累计新发恶性肿瘤7 435例,恶性肿瘤发病率为955.12/10万,标化发病率为458.05/10万。相较非糖尿病人群,糖尿病患者恶性肿瘤发病风险增加(RR=1.68,95%CI:1.68～1.70),其中20～39岁组2型糖尿病患者恶性肿瘤发病风险最高(RR=4.34,95%CI:3.54～5.32);随年龄增加,风险降低,但≥60岁组发病风险仍存在关联(RR=1.21, 95%CI:1.18～1.25)。结论 2型糖尿病患者中恶性肿瘤的发病风险增加。     

吡格列酮与二甲双胍联合治疗2型糖尿病抵抗的对照研究

目的 探讨观察吡格列酮与二甲双胍联合治疗2型糖尿病(T2DM)的临床疗效.方法 选择2010年6月-2011年11月在我院诊治的150例2型糖尿病患者,将其随机分为治疗组50例,其中男性30例,女性20例,平均年龄(44±6.4)岁,给予吡格列酮15 mg,每日1次,二甲双胍0.5 g,每日2次.治疗6个月以上;对照A组50例,男性28例,女性22例,平均年龄(43±7.5)岁.单用吡格列酮15 mg,每日1次;对照B组50例,男性30例,女性20例,平均年龄(45±7.8)岁,单用二甲双胍治疗0.5 g,每日2次.均治疗6个月以上.观察治疗前后空腹血糖(FPG)、餐后2 h血糖(P2hBG)、糖化血红蛋白(HbAlc)、空腹胰岛素(FINS)、餐后2 h胰岛素(P2hlNS)水平等各项指标的变化.结果 治疗后,治疗组的各项检查指标较单用吡格列酮组和单用二甲双胍组较治疗前明显好转(P<0.01).结论 吡格列酮联合二甲双胍治疗2型糖尿病有良好的临床疗效.     

社区居民2型糖尿病患病及影响因素分析

目的 了解天津市某社区50岁～居民糖尿病的患病情况及其影响因素,为进行有效防治提供参考依据.方法 采用现况调查方法,对天津市某社区50岁～居民共3 572人进行问卷调查、体格检查和血糖检测,采用Logistic回归分析糖尿病的相关因素.结果 调查人群糖尿病患病率为17.6%,男、女性患病率分别为16.8%和18.3%,差异无统计学意义(X~2=1.346,P＞0.05).不同年龄组之间糖尿病患病率不同(X~2=20.811,P＜0.01),随着年龄的增长,糖尿病患病率呈增高趋势,70岁～人群患病率达20.2%.多因素非条件Logistic回归分析结果显示,年龄、体质指数、腰围、糖尿病家族史和高血压与糖尿病发生有关.结论 天津地区调查人群糖尿病患病率处于全国较高水平,应重视加强综合防治.     

中国成年人静坐时间与2型糖尿病发病关系的前瞻性队列研究

目的 探讨我国成年人静坐时间与2型糖尿病发病的关系。方法 将2010年中国慢性病及其危险因素监测数据作为基线数据。从2010年监测点中选取8个省,每个省选择2个监测点（城市和农村各1个）作为随访点,排除基线2型糖尿病患者,共8 625人进入随访队列,2016－2017年进行随访调查,共随访到5 991人。采用Cox比例风险回归模型分析静坐时间与2型糖尿病发病的关系,并按性别、地区、城乡等不同特征进行亚组分析。结果 根据入选标准共纳入5 782名研究对象,平均随访6.4年（36 927.0人年）,随访期间共观察到2型糖尿病发病事件592例,2型糖尿病发病密度为16.0/千人年。多因素Cox回归分析结果显示,在调整了相关混杂因素之后,与静坐时间0.0~h/d者相比,静坐时间>6.0 h/d者糖尿病发病风险增加33%（HR=1.33,95% CI：1.05~1.68）。亚组分析显示结果和全人群结果略有不同,只在男性、吸烟、中心性肥胖、超重/肥胖、有糖尿病家族史、农村、东部和中部地区人群中发现,静坐时间过长与糖尿病发病风险有统计学关联。结论 静坐时间过长可增加2型糖尿病发病风险。应加强生活方式干预,减少成年人静坐时间,尤其是每日静坐时间>6.0 h的人群。     

Patients in waiting: a qualitative study of type 2 diabetes patients' perceptions of diagnosis

OBJECTIVE: Our aim was to examine how diagnosis is perceived by a sample of newly diagnosed type 2 diabetes patients. METHODS: A qualitative study was carried out in the Lothian region of Scotland using in-depth interviews of 40 newly diagnosed type 2 diabetes patients recruited from 16 general practices in four Local Health Care Co-operatives and three hospital clinics. Purposive selection ensured that the sample's demographic characteristics were broadly representative of newly diagnosed type 2 diabetes patients in Lothian/Scotland. RESULTS: Clarity, timing and authority of the diagnosis delivery were highly salient for patients. Many patients perceived their GP as unwilling to deliver/confirm the diagnosis. Patients who were not referred to hospital were unclear why a referral had not taken place. Those referred perceived confirmation of diagnosis by the consultant as a central reason. Waiting for a hospital appointment could be problematic for patients. Most wanted the diagnosis confirmed before they felt confident making lifestyle changes. Input from health services during the period prior to the hospital visit was highly valued. Waiting was taken by some asymptomatic patients to indicate that they did not have the condition. Others used a lengthy period of waiting to confirm their view that they had a 'milder' or 'less serious' form of diabetes than other patients. CONCLUSIONS: Adequate input from practitioners is needed to ensure that diagnosis is fully exploited as a crucial period in which patients learn to adapt to their condition. Being explicit about the diagnosis at first contact may avoid the problem of patients feeling 'in limbo' or uncertain whether they have type 2 diabetes. Practitioners should convey to patients that post-diagnosis/initial care is a process, stages of this process should be clarified to avoid misunderstanding and services should be integrated during this interim period to best effect.     

Validating the doubly weighted genetic risk score for the prediction of type 2 diabetes in the Lifelines and Estonian Biobank cohorts

As many cases of type 2 diabetes (T2D) are likely to remain undiagnosed, better tools for early detection of high-risk individuals are needed to prevent or postpone the disease. We investigated the value of the doubly weighted genetic risk score (dwGRS) for the prediction of incident T2D in the Lifelines and Estonian Biobank (EstBB) cohorts. The dwGRS uses an additional weight for each single nucleotide polymorphism in the risk score, to correct for “Winner's curse” bias in the effect size estimates. The traditional (single-weighted genetic risk score; swGRS) and dwGRS were calculated for participants in Lifelines (n = 12,018) and EstBB (n = 34,129). The dwGRS was found to have stronger association with incident T2D (hazard ratio [HR] = 1.26 [95% confidence interval: 1.10–1.43] and HR = 1.35 [1.28–1.42]) compared to the swGRS (HR = 1.21 [1.07–1.38] and HR = 1.25 [1.19–1.32]) in Lifelines and EstBB, respectively. Comparing the 5-year predicted risks from the models with and without the dwGRS, the continuous net reclassification index was 0.140 (0.034–0.243; p = .009 Lifelines), and 0.257 (0.194–0.319; p < 2 × 10⁻¹⁶ EstBB). The dwGRS provided incremental value to the T2D prediction model with established phenotypic predictors. It clearly distinguished the risk groups for incident T2D in both biobanks thereby showing its clinical relevance.     

2型糖尿病患者的执行功能现状及其影响因素研究

摘要:目的　探讨2型糖尿病患者执行功能现状及其主要影响因素。方法　选取三甲医院内分泌科确诊的2型糖尿病患者280例,采用执行功能缺陷综合征的行为学评价测验对患者进行执行功能的评测,采用自行设计问卷收集患者一般情况及病例资料。结果　2型糖尿病患者BADS测评总均分为（10.62±2.30）分。多元线性回归分析显示,性别、文化程度、糖尿病神经病变、病程及糖化血红蛋白控制情况是影响2型糖尿病患者执行功能的主要危险因素。结论　2型糖尿病患者执行功能水平偏低,主要与性别、文化程度、病程、神经病变及血糖控制情况有关。     

大连市社区居民2型糖尿病发病影响因素病例对照研究

目的 了解辽宁省大连市社区居民2型糖尿病的发病影响因素,为该地区制定2型糖尿病的防治策略和措施提供参考依据。方法 于2011年8-12月在大连市6个社区整群抽取2 396名过去未确诊患2型糖尿病的≥40岁社区居民进行问卷调查、体格检查和实验室检测,根据实验室检测结果将其中1 177例新发2型糖尿病患者和1 219名未患2型糖尿病人群分别作为病例组和对照组,分析大连市社区居民2型糖尿病发病的影响因素。结果 病例组患者饮酒、肉类摄入频率≥3次/d、超重、肥胖、中心性肥胖、有糖尿病家族史、高血压、总胆固醇边缘升高、总胆固醇升高、甘油三酯边缘升高、甘油三酯升高、低密度脂蛋白胆固醇边缘升高、低密度脂蛋白胆固醇升高的比例分别为31.78%、25.32%、44.27%、42.23%、73.41%、22.60%、69.67%、38.40%、27.78%、16.65%、26.51%、31.01%、19.12%,均高于对照组人群的24.36%、21.82%、43.40%、21.00%、48.97%、18.79%、42.82%、37.57%、18.95%,10.83%、10.67%、26.17%、12.80%,病例组患者体力活动高度活跃的比例（14.87%）低于对照组人群（18.70%）,差异均有统计学意义（均P<0.05）;多因素非条件logistic回归分析结果显示,饮酒、超重或肥胖、中心性肥胖、有糖尿病家族史、高血压、甘油三酯升高（包括边缘升高和升高）和低密度脂蛋白胆固醇升高（包括边缘升高和升高）是大连市社区居民2型糖尿病发病的危险因素,体力活动高度活跃是大连市社区居民2型糖尿病发病的保护因素。结论 大连市社区居民2型糖尿病发病的主要影响因素为饮酒、体力活动、体质指数、腰臀比、糖尿病家族史、血压以及甘油三酯和低密度脂蛋白胆固醇水平。     

Diabetes prevalence and socioeconomic status: a population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas

OBJECTIVE: To establish the relation between socioeconomic status and the age-sex specific prevalence of type 1 and type 2 diabetes mellitus. The hypothesis was that prevalence of type 2 diabetes would be inversely related to socioeconomic status but there would be no association with the prevalence of type 1 diabetes and socioeconomic status. SETTING: Middlesbrough and East Cleveland, United Kingdom, district population 287,157. PATIENTS: 4313 persons with diabetes identified from primary care and hospital records. RESULTS: The overall age adjusted prevalence was 15.60 per 1000 population. There was a significant trend between the prevalence of type 2 diabetes and quintile of deprivation score in men and women (chi 2 for linear trend, p < 0.001). In men the prevalence in the least deprived quintile was 13.4 per 1000 (95% confidence intervals (95% CI) 11.44, 15.36) compared with 17.22 per 1000 (95% CI 15.51, 18.92) in the most deprived. For women the prevalence was 10.84 per 1000 (95% CI 9.00, 12.69) compared with 15.48 per 1000 (95% CI 13.84, 17.11) in the most deprived. The increased prevalence of diabetes in the most deprived areas was accounted for by increased prevalence of type 2 diabetes in the age band 40-69 years. There was no association between the prevalence of type 1 diabetes and socioeconomic status. CONCLUSION: These data confirm an inverse association between socioeconomic status and the prevalence of type 2 diabetes in the middle years of life. This finding suggests that exposure to factors that are implicated in the causation of diabetes is more common in deprived areas.