糖耐量减低与2型糖尿病、心血管疾病关系的研究

目的:探讨糖耐量减低(IGT)与2型糖尿病、心血管疾病的关系。方法:回顾性分析102例有IGT的离退休及疗养员的资料。结果:5年后102例IGT有47％转为2型糖尿病,21.6％转为糖耐量正常,余32例仍为TGT,这32例IGT者62.5％合并有心血管疾病。结论:糖耐量减低、2—TDM患者心血管疾病的发生率较正常组显著增加(P<0.01);约50％IGT者5年后转变为2型糖尿病。     

及早发现糖尿病前期预防2型糖尿病

根据血糖数值不同（见下图）,糖尿病前期主要分为三种情况：单纯空腹血糖受损（IFG）、单纯糖耐量损害（IGT）和复合型糖调节受损（IFG＋IGT）。上述三种情况以IGT的发生率最高。     

糖尿病前期筛查的分歧与共识

目前将糖耐量减低(IGT)和空腹血糖受损(IFG)称为糖尿病前期,处于该阶段的个体发生糖尿病和心血管疾病的风险明显增高.美国糖尿病协会强烈主张单独应用空腹血糖(FBG)定义糖代谢状态,而世界卫生组织(WHO)则极力推荐对无症状高血糖人群应用标准化的口服75 g葡萄糖耐量试验(OGTT),联合空腹和负荷后2 h血糖来定义一个个体是否存在任何程度的糖代谢紊乱.关于这个问题的争论焦点主要是测定FBG或2 h血糖的可行性.由于OGTT整个过程至少需要2 h,因此不太适合群体研究.但是单独测定FBG以定义糖代谢状况往往存在假阴性风险,而且糖负荷后2 h血糖是诊断IGT的唯一方法.基于两方面的考虑,推荐在群体中进行糖尿病前期和未诊断糖尿病筛选时,首先应用费效比合理的筛查工具确定出高危人群,然后再进行OGTT以进一步确诊.     

冠心病合并糖调节受损或2型糖尿病患者冠状动脉特点及介入术后的观察

目的对比分析冠心病（CHD）合并糖调节受损（IGR）或2型糖尿病（T2DM）患者冠状动脉特点及介入术后观察。方法选择CHD患者1212例,按WHO诊断标准分为血糖正常（NGT）组、空腹血糖受损（IFG）组、糖耐量受损（配T）组及T2DM组,比较各组间冠状动脉病变程度及介入术后支架内再狭窄和晚期血栓的发生率。结果糖代谢异常各组在冠状动脉狭窄程度、病变范围、病变性质等方面的积分显著高于NGT组（P〈0．05或P〈0．01）。糖代谢异常患者支架内再狭窄率及T2DM患者晚期血栓形成率均显著增高（P〈0．01）。结论CHD合并IGR或T2DM患者,多个CHD危险因素并存,冠状动脉多支病变多见,病变程度严重、弥漫,且支架内再狭窄率及晚期支架内血栓形成率高。     

糖尿病及糖调节受损的诊断标准及其变迁

回顾了糖尿病诊断标准的产生背景、修改过程及依据,介绍了空腹血糖受损及糖耐量减低概念的提出及诊断切点的调整变化及这种变化所带来的益处。同时,比较了美国糖尿病学会与世界卫生组织糖尿病诊断标准的不同之处,指出目前糖尿病诊断中的不足之处。另外,糖化血红蛋白A1c可能成为糖尿病筛查和诊断的可靠指标。     

2型糖尿病的预防——糖耐量减退干预试验研究现状

2型糖尿病的自然史为一漫长的过程。由糖代谢正常发展至糖尿病之间有一历时数年或更久的过渡阶段 ,称为“糖耐量减退”(ＩＧＴ)。在ＩＧＴ阶段 ,糖代谢出现轻度异常 ,存在着胰岛素抵抗 ,胰岛 β细胞分泌胰岛素功能有轻度缺陷。ＩＧＴ目前还不能视为一种疾病 ,而是可发展为 2型糖尿病和心血管疾病的高危状态 ,其发病率与 2型糖尿病相仿或更高 ,发展为 2型糖尿病的年转变率约 2 %～ 10 %或更高。在ＩＧＴ阶段进行干预处理 ,有可能延缓、减少向糖尿病的转变 ,使其保持在ＩＧＴ阶段或转变为正常糖耐量状态。由此可见 ,2型糖尿病的预防 ,关键在于…     

淄博地区30～75岁人群糖尿病患病率调查

采用分层随机抽样的方法调查淄博地区5区3县30～75岁人群的糖尿病（DM）患病率;当筛查空腹血糖≥5.6 mmol/L时,采用口服75克葡萄糖糖耐量试验确定诊断.结果 淄博地区30～75岁人群DM患病率为7.75%,糖耐量减低（IGT）并空腹血糖受损（IFG）患病率7.97%,单纯IFG患病率12.39%,随年龄增加,DM及DM前期患病率明显增加.认为淄博地区DM患病率与1996年全国DM流行病学调查结果相比有明显增加,随着人口的老龄化和人均寿命延长,未来DM患病率还可能有较大幅度升高.     

2型糖尿病及IGT人群心血管疾病的预防策略

第18次国际糖尿病联盟暨欧洲糖尿病研究协会第39届年会于2003年8月在法国巴黎召开。在本次会议中，来自中国的糖尿病专家与加拿大阿卡波糖预防2型糖尿病(STOP—NIDDM)研究的第二负责人R．Josse等有机会就有关议题进行了深入的研讨。大量流行病学资料表明，餐后高血糖与心血管死亡密切相关。通过降低餐后血糖是否能够预防2型糖尿病或糖耐量减低(IGT)人群中的心血管事件的发病，甚至可能降低心血管死亡风险?跨国多中心的STOP-NIDDM试验证实，阿卡波糖干预IGT人群，可降低2型糖尿病和高血压、心肌梗死及任一心血管事件的发病危险。     

2007年成都地区糖尿病、糖尿病前期的流行病学调查

目的了解成都地区成年人DM和DM前期患病率的流行病学情况。方法用多级多层整体抽样方法,于2007年调查成都玉林、龙泉两个地区共计2248人。DM诊断采用1999年WHO标准。结果DM和DM前期的总患病率分别为11．1％、14．2％;标化后分别为8．2％、12．2％;男性DM患病率高于女性（P〈0．05）,两性问DM前期患病率无统计学差异（P〉0.05）。DM及DM前期患病率随年龄增长而增加（P〈0．05）。Logistic回归分析显示DM的危险因素有年龄、腰围、静息心率、BP和TG。DM前期危险因素分别为年龄、高血压史、静息心率、BMI、TC、血尿酸。HDL-C为保护性因素。结论成都地区的DM及DM前期患病率均较高,且有进一步增加趋势,须及时采取有效措施,干预糖代谢异常的流行。     

糖尿病和糖尿病前期的诊断

糖尿病是一组由于血糖水平过高而引起组织、器官功能及结构异常的疾病。血糖是一种连续的变量,用一个时间点的血糖水平作为疾病诊断的切割点显然是不合理的。因此,糖尿病和糖尿病前期血糖诊断标准的确立是一种相对水平,即此切割点以上的血糖状态引发的高血糖特征性病变开始出现     

Total serum bilirubin and 8-year incident type 2 diabetes mellitus: The Korean Genome and Epidemiology Study

Aim

In this study, the impact of serum bilirubin on new-onset type 2 diabetes mellitus (T2DM) in Korean adults was investigated.

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.     

糖代谢异常和糖尿病患者脉压的研究

目的:脉压与心脑血管疾病相关,糖代谢异常和2型糖尿病也是心脑血管疾病的危险因子,但是脉压与糖代谢异常、2型糖尿病的关系未见在我国人群中的研究报道。方法:对2 420例常规健康体检者进行血浆总胆固醇、甘油三酯、收缩压、舒张压、脉压和体重指数(BMI)测定,观察脉压与糖代谢异常和2型糖尿病的关系。为了避免年龄对脉压的影响,我们将所有被检查者以年龄分为3组(40~54岁组、55~69岁组和≥70岁组)。结果:40~54岁者脉压、收缩压、舒张压、BMI和甘油三酯在糖代谢异常和2型糖尿病组明显升高(P<0.01),总胆固醇在各组之间差异无显著性(P>0.05)。55~69岁者只有脉压在糖代谢异常和2型糖尿病组中明显升高(P<0.05)。年龄≥70岁组中,所有观察指标在各组之间差异均无显著性(P>0.05)。结论:脉压在年龄<70岁的糖代谢异常和2型糖尿病患者中升高。脉压升高预示着心脑血管疾病危险因素的存在。     

High prevalence of type 2 diabetes mellitus in affluent urban Indians

The highest prevalence of type 2 diabetes mellitus in developing countries occurs in the upper socio-economic group, but this has not been well documented in Indians. The age and sex standardized prevalence of diabetes in 1112 affluent adult Indian subjects was 21.1%. This is the highest prevalence of diabetes reported from India.     

Report from an effort to prevent type 2 diabetes development in primary care

BackgroundIn a clinical trial 2009–2012, individuals with prediabetes were randomised to a lifestyle intervention (LI) focused on physical activity or care as usual (CAU), with the aim of reducing development of type 2 diabetes (T2DM). At study termination after three years, there was a significantly less of an increase in insulin resistance in LI compared with the CAU group. The aim of this extended follow-up was to investigate whether positive results concerning metabolic variables remained five years after study termination.MethodAll participants from the original study were contacted for a new follow-up with an oral glucose tolerance test, anthropometric measurements, blood pressure and blood samples. Questionnaires about lifestyle were completed.ResultsA total of 69 of the original 123 participants were examined, and personal data for another five participants were collected from the medical charts (n = 74). The LI group showed a decrease in diastolic blood pressure (?4 mmHg, CI 95% 0.8–6.8, p = 0.014) and body weight (?3 kg, CI 95% 1.2–4.9, p = 0.002) since base-line. Weight loss in the LI group was significantly greater compared with weight loss in the CAU group (?3 kg, CI 0.1–5.9, p = 0.044). Insulin resistance markers and incident T2DM were similar among the groups.ConclusionAlthough without modifying the incidence of diabetes or the level of insulin resistance, a physical activity intervention may be used to induce sustainable weight change in subjects with prediabetes at the primary care level.     

Increased liver markers are associated with higher risk of type 2 diabetes

AIM: To investigate the association between liver markers and the risk of type 2 diabetes (T2DM) and impaired fasting glucose (IFG).METHODS: A total of 8863 participants (3408 men and 5455 women) over 30 years of age were analyzed from the fifth Korean National Health and Nutrition Examination Survey (2010-2011). The associations of serum liver markers such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT, and gamma-glutamyltransferase (GGT) with T2DM and IFG were analyzed using logistic regression models. Participants were divided into sex-specific quartiles on the basis of liver markers.RESULTS: The prevalence of T2DM and IFG were 11.3% and 18.3%. Increasing quartiles of ALT and GGT were positively and AST/ALT were negatively correlated with T2DM and IFG. Analysis of the liver marker combinations showed that if any two or more markers were in the highest risk quartile, the risks of both T2DM and IFG increased significantly. The risk was greatest when the highest ALT and GGT and lowest AST/ALT quartile were combined, with the risk of T2DM at 3.21 (95%CI: 1.829-5.622, P < 0.001) in men and 4.60 (95%CI: 3.217-6.582, P < 0.001) in women. Men and women with the highest AST and ALT and lowest AST/ALT quartile had a 1.99 and 2.40 times increased risk of IFG.CONCLUSION: Higher levels of GGT and ALT and lower AST/ALT within the physiological range are independent, additive risk factors of T2DM and IFG.     

二甲双胍和食物纤维在糖耐量低减人群向2型糖尿病发展中的干预作用

目的　观察二甲双胍和食物纤维预防糖耐量低减 (IGT)人群进展为 2型糖尿病 (DM)的作用。　方法　以口服 75 g葡萄糖耐量试验 (OGTT)确诊 (WHO标准 )的 IGT2 93例中男 2 16例 ,女 77例。入选者年龄 35岁以上 ,体重指数 (BMI)在 19kg/ m2以上。随机分为对照组 72例 ,教育组 5 7例 ,食物纤维组 84例 ,二甲双胍组 80例。对照组进行一般的健康教育 ;教育组进行饮食指导 ,每半年1次 ;食物纤维组除健康教育外 ,每日口服食物纤维 12 g;二甲双胍组每日口服二甲双胍 0 .75 g,分 3次餐后口服。对四组参试者每半年作 1次 OGTT,同时测身高、体重、BMI、12 h尿白蛋白 ,复查日当天不服干预药物或食物纤维。共观察 3年。若 2次 OGTT或最后 1次复查结果为 DM,则判断为已发展为 DM。　结果　 2 93例 IGT在观察中有 2 3例 (7.8% )退出。空腹血糖 (FBS)和服糖后 1h血糖 (1hPBS)在对照组、教育组和食物纤维组均较治疗前略有升高 ,但在二甲双胍治疗组均有下降。四组间FBS比较 F=8.118,P<0 .0 1,四组间 1h PBS比较 F=3.6 97,P=0 .0 12。观察期末对照组 16例 (2 5 .0 % )、教育组 11例 (2 1.6 % )、食物纤维组 13例 (16 .3% )、二甲双胍组 7例 (9.3% )转化为 DM,二甲双胍组在治疗后 DM转化率明显低于对照组 (χ2 =6 .318,P<0 .0     

Influence of endogenous hyperinsulinism on high density lipoprotein2 level in type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance

We determined the insulin response to an oral glucose ingestion and levels of serum lipoproteins in 25 untreated patients with type 2 diabetes mellitus, in 26 subjects with impaired glucose tolerance (IGT), and in 35 non-diabetic control subjects. The three groups had similar compositions with respect to age and sex distribution. The levels of VLDL triglycende in the subjects with type 2 diabetes or IGT were higher than those in controls. Serum HDL- and HDL₂ cholesterol were significantly decreased in type 2 diabetics, and the subjects with IGT showed a similar tendency. Serum apolipoprotein A-II levels were lower in the male subjects with type 2 diabetes or IGT than in controls. Insulin reponse, i.e., sum of immunoreactive insulin (IRI) levels at basal, 30, 60, 90 and 120 min after a 75-g oral glucose load, negatively correlated to HDL and HDL₂ cholesterol levels (r = −0.396, P < 0.05; r = −0.482, P < 0.001, respectively), and positively correlated to VLDL triglyceride values (r = 0.485, P < 0.001) in the male subjects with type 2 diabetes or IGT. In the female subjects, fasting plasma IRI values significantly correlated to HDL cholesterol (r = −0.496, P < 0.05). There was a significant negative correlation between the concentrations of HDL₂ cholesterol and VLDL trgglyceride. These data show that lipoprotein metabolism, not only in type 2 diabetics, but also in IGT tends to show changes such as decreased HDL₂ cholesterol and increased VLDL triglyceride levels, and which might be related to the hypersecretion of endogenous insulin.     

Associations between obesity indices and both type 2 diabetes and impaired fasting glucose among West African adults: Results from WHO STEPS surveys

Background and aimVarious obesity indices such as BMI, waist circumference (WC), waist-hip ratio, (WHR) and waist-to-height ratio (WHtR) are associated with the risk of type 2 Diabetes Mellitus (T2DM). Given few studies examining the strength of the association in this population, we aimed to identify which obesity indices are most strongly associated with T2DM and impaired fasting glucose (IFG) among adults from five West African countries.Methods and resultsData from 15,520 participants from the World Health Organisation (WHO) STEPs surveys in Burkina Faso, Benin, Mali, Liberia, and Ghana were included in analyses. Multinomial logistic regression was used to calculate the relative risk (RR) per standard deviation (SD) of each anthropometric measure, modelled as both continuous variables and as categorical variables based on established cut-points. In the analyses with continuous variables, the unadjusted RRs for T2DM per SD were 1.30 (1.23, 1.37) for body mass index (BMI); 1.56 (1.46, 1.67) for WC; 2.57 (2.15, 3.09) for WHtR and 1.16 (1.03, 1.31) for WHR. WHtR showed the strongest association with T2DM in all adjusted analyses. For models using categorical variables based on established cut-points, obesity defined using waist circumference (OB-WC) and OB-BMI showed the strongest associations with T2DM, and OB-WHR, the weakest association in all adjusted analyses.ConclusionWHtR and WC appear to be the indices most strongly associated with T2DM and IFG respectively. Given its simplicity, WC may be the metric that most usefully conveys risk for T2DM in West African adults.