妊娠期糖尿病和糖耐量减低的营养治疗研究

目的:研究营养治疗对妊娠期糖尿病(GDM)和糖耐量减低(IGT)的意义.方法:对来我院围产检查并分娩的610例孕妇,采用50 g葡萄糖负荷试验(GCT)筛查,阳性者再行口服葡萄糖耐量试验(OGTT),以诊断GDM和IGT;对于GDM和IGT进行严格饮食控制,监测其空腹和餐后2 h血糖变化情况,并跟踪其围生期病死率、巨大儿和新生儿患病率情况.结果:50 g GCT阳性者140例,其中确诊为GDM 15例,IGT 61例;饮食控制后GDM组空腹和餐后2 h血糖均有明显下降(P＜0.05);IGT组餐后2 h血糖有明显下降(P＜0.05).两组的围生期病死率、巨大儿和新生儿患病率均低于国内相关文献报道,其中IGT组的巨大儿和新生儿患病率均低于GDM组(P＜0.05).结论:对所有孕妇应做50 g GCT筛查;严格合理的饮食控制对GDM和IGT的血糖控制和妊娠结局具有重要意义.     

中心性肥胖与糖调节受损、2型糖尿病的关系

目的探讨以腰臀比(waist-to-hip ratio,WHR)为指标的中心性肥胖与空腹血糖受损、糖耐量异常和2型糖尿病(type 2 diabetes,T2DM)发病的关系。方法采用队列研究,对684名社区居民追踪随访3年后,运用单因素及多因素Logistic回归分析中心性肥胖与糖调节受损(impaired glucose regulation,IGR)及T2DM发病的关系。结果WHR异常者发生IGR和T2DM的风险分别是正常者的2.32(95%CI:1.65~3.26)倍和2.48(95%CI:1.09~5.63)倍;控制混杂因素后,WHR异常组发生IGR(RR=1.60,95%CI:1.14~2.23)和T2DM(RR=1.89,95%CI:1.21~2.36)的风险仍然比WHR正常组高。结论中心性肥胖是IGR及T2DM发病的危险因素。     

血清超敏C反应蛋白检测在糖耐量减低及糖尿病患者中的临床意义

目的比较不同糖耐量受试者血清超敏C反应蛋白（hs-CRP）水平,探讨hs-CRP检测在糖耐量减低（IGT）及糖尿病患者中的作用。方法所有受试者均行口服葡萄糖耐量试验（OGTT）,用免疫透射比浊法测定正常糖耐量（NGT）、IGT、2型糖尿病（T2DM）受试者血清hs-CRP水平。结果NGT、IGT和T2DM者血清hs-CRP水平分别为（1．57±0．46）、（2．84±0．48）、（4．18±0．76）mg／L,hs-CRP分别与体重指数、收缩压、舒张压、空腹血糖、OGTT试验中2h血糖、三酰甘油和总胆固醇呈正相关。结论T2DM患者早在IGT阶段就已经存在炎性反应,炎性反应可能参与了T2DM的发生和发展。hs-CRP作为炎性反应因子,在预测和监视T2DM方面有重要意义。     

血清超敏C反应蛋白检测在糖耐量减低及糖尿病患者中的临床意义

目的 比较不同糖耐量受试者血清超敏C反应蛋白(hs-CRP)水平,探讨hs-CRP检测在糖耐量减低(IGT)及糖尿病患者中的作用.方法 所有受试者均行口服葡萄糖耐量试验(OGTT),用免疫透射比浊法测定正常糖耐量(NGT)、IGT、2型糖尿病(T2DM)受试者血清hs-CRP水平.结果 NGT、IGT和T2DM者血清hs-CRP水平分别为(1.57±0.46)、(2.84±0.48)、(4.18±0.76)mg/L,hs-CRP分别与体重指数、收缩压、舒张压、空腹血糖、OGTT试验中2h血糖、三酰甘油和总胆固醇呈正相关.结论 T2DM患者早在IGT阶段就已经存在炎性反应,炎性反应可能参与了T2DM的发生和发展.hs-CRP作为炎性反应因子,在预测和监视T2DM方面有重要意义.     

糖尿病和糖耐量低减患者生命质量评价

目的 了解糖尿病和糖耐量低减患的生命质量,并探讨其影响因素。方法 采用SF-36量表评价：108例糖尿病、109例糖耐量低减和116例糖耐量正常的生命质量,并研究其影响因素。结果 糖尿病患中,自我确认健康感觉非常好或很好占12．04％,与同龄人比较,健康感觉好或较好占62．04％;糖耐量低减患中上述比例较高,分别为13．76％和69．72％;生命质量综合评分很好或好的比例在糖尿病患为72．23％,糖耐量低减患为83．49％。糖尿病患生命质量已普遍下降,生命质量各维度评分最低为情绪角色功能,最高为躯体功能,波动在58．33-87．38之间,其中躯体功能、躯体角色功能、总体健康、精力和综合评分显低于糖耐量正常,精力、心理健康和综合评分显低于糖耐量低减;糖耐量低减患生命质量各维度有不同程度的损害,但其生命质量评分与糖耐量正常无统计学差异。相关分析显示,年龄、职业、离退休、病程、糖尿病症状数、并发症数量、空腹血糖和餐后2h血糖水平对糖尿病患生命质量有影响。结论 提高糖尿病患的生命质量,应该从疾病早期开始。控制血糖稳定,重视患的心理治疗和采取有针对性的措施,可提高不同特征患的生命质量。     

Pathophysiological interrelations of obesity, impaired glucose tolerance, and arterial hypertension

There is a large amount of epidemiological and clinical evidence for associations among obesity, impaired glucose tolerance, and arterial hypertension; nevertheless, the pathophysiological mechanisms underlying these associations have not yet been elucidated. In this article, some working hypotheses are discussed, and original data are presented from two studies focusing on these pathophysiological interrelations. A case-control study of obese normotensive and hypertensive patients, matched for sex, age, and degree of overweight, has shown that obese patients with associated arterial hypertension have higher fasting serum insulin levels and reduced glucose tolerance compared with their normotensive peers. A second study compared subjects with impaired glucose tolerance with a control group of clinically healthy individuals of comparable sex, age, and body mass index, and it revealed that impaired glucose tolerance is associated with significantly higher blood pressure levels, independent of body weight. The results of the two studies together suggest that the association between hypertension and impaired glucose tolerance is independent of overweight; they also give some support to the hypothesis that hyperinsulinemia may contribute to the development of high blood pressure in obese patients.     

Post-challenge glucose concentration, impaired glucose tolerance, diabetes, and cancer mortality in men.

The possibility that diabetes is associated with an elevated risk of cancer mortality has been discussed for many years. Recently, Levine et al. (Am J Epidemiol, 1990; 131:254-62) approached this issue by relating post-load plasma glucose concentration to cancer mortality. For men, there appeared to be a positive association between post-load glucose and mortality from cancer for all sites combined and for some specific sites. However, that analysis was based on only 298 cancer deaths among 11,521 men followed for 12 years. The current authors explored this issue in a cohort of 18,274 male civil servants, among whom there were 1,282 cancer deaths over 18-20 years of follow-up. There was no association between post-load glucose and cancer mortality, except for pancreatic cancer. A role for asymptomatic hyperglycemia in the etiology of cancer is not supported by the results of the present study.     

正常糖耐量及糖调节受损人群3年转归情况分析

目的探讨非糖尿病人群随访3年糖代谢转归情况,为糖尿病的早期防治及高危人群的筛查提供参考依据。方法采用分层随机抽样方法在山东省青岛市抽取3 844名35～74岁非糖尿病人群作为研究对象,将研究对象分为正常糖耐量(NGT)组和糖调节受损(IGR)组,其中IGR组再分为空腹血糖受损(IFG)组、糖耐量异常(IGT)组和IFG+IGT组,观察2006—2009年3年中研究对象糖代谢指标转归情况。结果青岛市随访3年非糖尿病人群2型糖尿病(T2DM)累积发病率为11.2%;其中男性和女性人群T2DM 3年累积发病率分别为12.9%和10.3%,差异无统计学意义(P>0.05);城市和农村地区人群T2DM 3年累积发病率分别为9.1%和12.0%,其中城市地区45岁～、55岁～和65～74岁人群T2DM 3年累积发病率分别为6.4%、12.5%和11.5%,均低于农村地区的11.1%、19.9%和23.3%,差异均有统计学意义(P<0.01),城市和农村地区35～44岁人群T2DM 3年累积发病率分别为9.0%和6.3%,差异无统计学意义(P>0.05);NGT、IGR、IFG、IGT和IFG+IGT组T2DM 3年累积发病率分别为7.1%、20.8%、20.9%、14.5%和32.3%;各组T2DM 3年累积发病率比较,IFG、IGT和IFG+IGT组T2DM 3年累积发病率均高于NGT组(P<0.05),IFG+IGT组T2DM 3年累积发病率分别高于IFG、IGT组,差异均有统计学意义(P<0.05)。结论青岛市非糖尿病人群糖尿病发病率较高,农村地区≥45岁人群和IGR人群是T2DM的高危人群。     

The prevalence of diabetes mellitus and impaired glucose tolerance studied by 75 gram oral glucose tolerance test in a rural island population]

A mass health examination was performed to assess the glucose tolerance of inhabitants of the island of Ojika, in the Goto islands, Nagasaki prefecture Japan. There were 554 males and 820 females older than 34 years who participated in the mass health examination, a response rates of 42 percent and 52 percent for males and females respectively. Serum glucose levels after overnight fasting and at 2 hours after a 75 gram oral glucose tolerance were used with WHO criteria to classify individuals. Among these subjects, the prevalence of diabetes mellitus increased with age, with a prevalence of diabetes mellitus of around 10 percent in the older subjects. The prevalence for males was higher than that for females. Prevalences of impaired glucose tolerance were roughly in the 15-25 percent range and did not show clear differences among different age groups and sexes. From a questionnaire survey of all island inhabitants, it was considered that the degree of bias of the results was small, if any. The true prevalence for all the inhabitants may be a little larger than the observed prevalence of these subjects.     

Cardiac risk profile in diabetes mellitus and impaired fasting glucose

OBJECTIVE: Mortality of diabetic patients is higher than that of the population at large, and mainly results from cardiovascular diseases. The purpose of the present study was to identify the prevalence of cardiovascular risk factors in subjects with diabetes mellitus (DM) or abnormal fasting glucose (FG) in order to guide health actions. METHODS: A population-based cross-sectional study was carried out in a representative random cluster sampling of 1,066 adult urban population (> or =20 years) in the state of Rio Grande do Sul between 1999 and 2000. A structured questionnaire on coronary risk factors was applied and sociodemographic characteristics of all adults older than 20 years living in the same dwelling were collected. Subjects were clinically evaluated and blood samples were obtained for measuring total cholesterol and fasting glycemia. Statistical analysis was performed using Stata 7 and a 5% significance level was set. Categorical variables were compared by Pearson's chi-square and continuous variables were compared using Student's t-test or Anova and multivariate analysis, all controlled for the cluster effect. RESULTS: Of 992 subjects, 12.4% were diabetic and 7.4% had impaired fasting glucose. Among the risk factors evaluated, subjects who presented any kind of glucose homeostasis abnormality were at a higher prevalence of obesity (17.8, 29.2 and 35.3% in healthy subjects, impaired fasting glucose and DM respectively, p<0.001), hypertension (30.1, 56.3 and 50.5% in healthy subjects, impaired fasting glucose and DM, respectively, p<0.001), and hypercholesterolemia (23.2, 35.1 and 39.5 in healthy subjects, impaired fasting glucose and DM respectively, p=0.01). CONCLUSION: Subjects with any kind of glucose homeostasis abnormality represent a group, which preventive individual and population health policies should target since they have higher prevalence of coronary artery disease risk factors.     

Plasma adiponectin levels in high risk African-Americans with normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes

OBJECTIVE: We studied plasma adiponectin, insulin sensitivity, and insulin secretion before and after oral glucose challenge in normal glucose tolerant, impaired glucose tolerant, and type 2 diabetic first degree relatives of African-American patients with type 2 diabetes. RESEARCH METHODS AND PROCEDURES: We studied 19 subjects with normal glucose tolerance (NGT), 8 with impaired glucose tolerance (IGT), and 14 with type 2 diabetes. Serum glucose, insulin, C-peptide, and plasma adiponectin levels were measured before and 2 hours after oral glucose tolerance test. Homeostasis model assessment-insulin resistance index (HOMA-IR) and HOMA-beta cell function were calculated in each subject using HOMA. We empirically defined insulin sensitivity as HOMA-IR<2.68 and insulin resistance as HOMA-IR>2.68. RESULTS: Subjects with IGT and type 2 diabetes were more insulin resistant (as assessed by HOMA-IR) when compared with NGT subjects. Mean plasma fasting adiponectin levels were significantly lower in the type 2 diabetes group when compared with NGT and IGT groups. Plasma adiponectin levels were 2-fold greater (11.09+/-4.98 vs. 6.42+/-3.3811 microg/mL) in insulin-sensitive (HOMA-IR, 1.74+/-0.65) than in insulin-resistant (HOMA-IR, 5.12+/-2.14) NGT subjects. Mean plasma adiponectin levels were significantly lower in the glucose tolerant, insulin-resistant subjects than in the insulin sensitive NGT subjects and were comparable with those of the patients with newly diagnosed type 2 diabetes. We found significant inverse relationships of adiponectin with HOMA-IR (r=-0.502, p=0.046) and with HOMA-beta cell function (r=-0.498, p=0.042) but not with the percentage body fat (r=-0.368, p=0.063), serum glucose, BMI, age, and glycosylated hemoglobin A1C (%A1C). DISCUSSION: In summary, we found that plasma adiponectin levels were significantly lower in insulin-resistant, non-diabetic first degree relatives of African-American patients with type 2 diabetes and in those with newly diagnosed type 2 diabetes. We conclude that a decreased plasma adiponectin and insulin resistance coexist in a genetically prone subset of first degree African-American relatives before development of IGT and type 2 diabetes.     

2型糖尿病和葡萄糖耐量异常患者游离脂肪酸升高及其意义

目的　观察 2型糖尿病 (DM)和葡萄糖耐量异常 (IGT)患者血清游离脂肪酸 (FFA)的水平 ,探讨FFA与胰岛素(INS)、胰岛素抵抗 (IR)和甘油三酯 (TG)的关系。方法　采用酶法测定 2 0例 2型DM和 2 0例IGT患者口服葡萄糖耐量试验 (OGTT) 0和 2h血清FFA水平 ,同步测定血浆葡萄糖 (PG)、血清INS以及空腹TG和胆固醇 (TC) ,并与 2 0例正常人对照。结果　 2型DM和IGT患者OGTT 0和 2hINS均显著高于正常对照组 ,且 2型DM患者INS高于IGT患者 ,P <0 .0 5 ;空腹FFA和胰岛素抵抗指数 (HOMA -IR) 2型DM患者高于IGT患者 ,IGT患者高于正常对照组 ,P <0 .0 1;TG和OGTT 2hFFA 2型DM患者高于IGT患者和正常对照组 ,P <0 .0 5 ,而IGT患者和正常对照组之间比较差异无显著性 ;多元逐步回归显示空腹FFA是HOMA -IR的独立影响因素。结论　不仅 2型DM患者而且IGT患者存在FFA异常升高 ,FFA升高与IR有关 ;2型DM和IGT患者存在IR和脂代谢紊乱 ,FFA反映脂代谢紊乱可能较TG更灵敏的指标     

Prevalence of diabetes mellitus and impaired glucose tolerance in the middle-aged population of three areas in Finland.

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was determined in a random sample of the population aged 45-64 years in three areas of Finland. The two-hour oral glucose tolerance test was repeated in subjects whose first test suggested abnormal glucose tolerance. In the final classification, based on the results of the two tests, the age-standardized prevalence of diabetes, according to the WHO criteria was 5.7% (95% confidence interval (CI): 4.3-7.1) in men and 4.6% (95% CI: 3.6-5.0) in women. The prevalence of IGT was 3.1% (95% CI: 2.1-4.1) in men and 5.1% (95% CI: 3.9-6.3) in women. Among those aged 55-64 years the prevalence was 6.9% in men and 7.5% in women. The prevalence of diabetes and IGT were not different between the three areas. The age-specific mean values of fasting and two-hour blood concentrations and the 90th percentiles of the blood glucose distributions were also not different between the areas. The prevalence of IGT and diabetes increased with age more steeply among women than men. The median of fasting blood glucose did not change, but the 90th percentile increased with increasing age. The entire distribution of two-hour blood glucose shifted towards higher values with ageing, but the major increase was seen for the 95th percentile. The majority of the diabetic subjects were aware of their condition. The awareness was better among men than women.     

Differences by sex in the prevalence of diabetes mellitus,impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa: a systematic review and meta-analysis

Objective

To assess differences between men and women in the prevalence of diabetes mellitus, impaired fasting glycaemia and impaired glucose tolerance in sub-Saharan Africa.

Methods

In September 2011, the PubMed and Web of Science databases were searched for community-based, cross-sectional studies providing sex-specific prevalences of any of the three study conditions among adults living in parts of sub-Saharan Africa (i.e. in Eastern, Middle and Southern Africa according to the United Nations subregional classification for African countries). A random-effects model was then used to calculate and compare the odds of men and women having each condition.

Findings

In a meta-analysis of the 36 relevant, cross-sectional data sets that were identified, impaired fasting glycaemia was found to be more common in men than in women (OR: 1.56; 95% confidence interval, CI: 1.20–2.03), whereas impaired glucose tolerance was found to be less common in men than in women (OR: 0.84; 95% CI: 0.72–0.98). The prevalence of diabetes mellitus – which was generally similar in both sexes (OR: 1.01; 95% CI: 0.91–1.11) – was higher among the women in Southern Africa than among the men from the same subregion and lower among the women from Eastern and Middle Africa and from low-income countries of sub-Saharan Africa than among the corresponding men.

Conclusion

Compared with women in the same subregions, men in Eastern, Middle and Southern Africa were found to have a similar overall prevalence of diabetes mellitus but were more likely to have impaired fasting glycaemia and less likely to have impaired glucose tolerance.     

Distribution of fasting plasma glucose and prevalence of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes in the Mexican paediatric population

Published data on the distribution of fasting plasma glucose (FPG) in children are scarce. We therefore set out to examine the distribution of FPG and determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes (T2-DM) in Mexican children aged 6–18 years in a community-based cross-sectional study. A total of 1534 apparently healthy children were randomly enrolled and underwent an oral glucose tolerance test. IFG was defined by an FPG value between ≥100 and <126 mg/dL, IGT by glucose concentration 2-h post-load between ≥140 and <200 mg/dL, and T2-DM by glucose concentration 2-h post-load ≥200 mg/dL.
The FPG level at the 75^th percentile of distribution was 98.0, 100.0 and 99.0 mg/dL for children aged 6–9, 10–14 and 15–18 years, respectively; the 95^th percentile of FPG was greater than 100 mg/dL for all the age strata. In the population overall, the prevalences of IFG, IGT, and T2-DM were 18.3%, 5.2% and 0.6%, respectively. Among obese children and adolescents, the prevalences of IFG, IGT, IFG + IGT and T2-DM were 19.1%, 5.7%, 2.5% and 1.3%. Our study shows a high prevalence of prediabetes and is the first that reports the distribution of FPG in Mexican children and adolescents.     

糖耐量异常及2型糖尿病患者血浆纤溶酶原激活物抑制物-1水平与动脉粥样硬化关系的探讨

目的探讨糖耐量异常(IGT)及2型糖尿病(T2DM)患者血浆纤溶酶原激活物抑制物-1(PAI-1)水平与颈动脉内膜-中层厚度(IMT)的关系,进而评价PAI-1水平与动脉粥样硬化的关系。方法以19例IGT患者(IGT组)和141例T2DM患者(T2DM组)为研究对象,并选择52例健康人作为对照组,测定PAI-1水平、IMT。结果(1)IGT组及T2DM组IMT与对照组比较差异有统计学意义;T2DM组IMT较IGT组明显增厚,差异有统计学意义。(2)对照组与IGT组、T2DM组PAI-1水平差异有统计学意义;IGT组与T2DM组PAI-1水平差异有统计学意义;合并大血管病变的T2DM组PAI-1水平与无大血管病变的T2DM组差异有统计学意义。(3)通过对IMT多元回归发现,PAI-1与IMT具有明显的相关性。结论(1)IGT阶段IMT就已经出现增厚,提示动脉粥样硬化在IGT阶段就已开始。临床T2DM阶段IMT明显增厚,且与IGT组的差异有统计学意义。(2)PAI-1水平与IMT密切相关,提示升高的PAI-1水平可能是IGT和T2DM大血管病变的重要危险因素之一。     

Prevalence rates of impaired glucose tolerance and diabetes mellitus in various Pacific populations according to the new WHO criteria

This report gives the prevalence rates of impaired glucose tolerance (IGT) and diabetes mellitus (DM) for several Micronesian, Polynesian, and Melanesian populations in the Pacific region according to the new WHO criteria.