空腹血糖异常、糖耐量减低患者血清胰岛素水平的变化及其意义

目的 观察空腹血糖异常(IFG)、糖耐量减低(IGT)患者血清胰岛素水平的变化。方法 对50例空腹血糖和糖耐量正常者(NGT)、40例IFC和80例IGT患者行口服葡萄糖耐量试验(0GTT)，用氧化酶法检测血糖，用放免法测定血清空腹及餐后2小时胰岛素。结果 IFG、IGT组空腹血糖、空腹胰岛素水平及胰岛素敏感指数较NGT组明显升高(P＜0.05或P＜0．01)，IFG组胰岛素敏感指数与IGT组比较无显著性差异(P＞0．05)。结论 在IFG、IGT状态下已经存在胰岛素抵抗，而且在程度上两者间并没有显著性差异，应早期干预治疗。     

空腹血糖受损与糖耐量减低的概念及表现谱的差异和对策

1997年美国糖尿病学会(ADA)提出空腹血糖受损(IFG)的概念,2003年11月ADA提出IFG下限诊断标准从6.1mmol/L下调到5.6mmol/L。IFG与糖耐量减低(IGT)人群进展为2型糖尿病的危险均较正常血糖人群高,但两者的表现谱却存在许多差异,如两者的患病率具有性别及种族差异;胰岛素分泌及胰岛素抵抗状况也不同;两者与血管病变的关系及血管病变的发生率和病死率也有差异。因此,基于IFG、IGT的病理生理学应对其采取相应的干预措施。     

空腹血糖受损患者糖耐量异常及影响因素分析

目的了解空腹血糖受损(IFG)患者糖耐量异常(IGT)情况及其影响因素。方法纳入空腹血糖为5.6~6.1 mmol/L的IFG患者337例,检测患者口服75克葡萄糖后2小时血糖等资料,分析患者IGT情况及其影响因素。结果纳入的337例IFG患者中46.6%(157/337)伴有IGT。口服葡萄糖耐量异常和正常组超重和肥胖率分别为75.0%和63.1%(P0.05);口服葡萄糖耐量异常组甘油三酯水平显著高于正常组,高密度脂蛋白胆固醇水平低于正常组,均有统计学差异(P0.05)。多因素Logistic回归分析结果显示,年龄、体重指数、甘油三酯水平是IFG患者葡萄糖耐量异常的影响因素,相对危险分别为:1.06(95%CI:1.03~1.08);1.11(95%CI:1.05~119);1.58(95%CI:1.23~2.09)。进一步对体重正常者发生糖耐量异常的影响因素进行分析,除年龄外,甘油三酯水平是空腹血糖受损患者糖耐量异常的影响因素,相对危险为2.10(95%CI:1.29~3.43)。结论空腹血糖受损患者约半数伴有糖耐量异常,体重指数和甘油三酯水平是空腹血糖受损患者糖耐量异常的影响因素。     

空腹血糖异常人群胰岛素分泌功能及胰岛素抵抗状态的探讨

目的　探讨空腹血糖异常人群的胰岛素分泌及胰岛素抵抗状态。　方法　选择包钢糖尿病普查中复查口服葡萄糖耐量试验 (OGTT) 3985例 ,分为 6组 :正常糖耐量 (NGT)组 2 5 88例 ,异常空腹血糖 (IFG)组 2 72例 ,糖耐量减低 (IGT)组 4 4 9例 ,空腹血糖异常伴糖耐量减低 (IFG/ IGT)组116例 ,新诊断糖尿病 (DM1)组 338例 ,已知糖尿病 (DM2 )组 2 2 2例。测腰围、体重指数、血压、血脂及血浆胰岛素 ,应用稳态模式胰岛素抵抗指数 (HOMA- IR)作为胰岛素抵抗指标 ,稳态模式胰岛 β细胞功能指数 (HBCI)及胰岛素分泌指数 (IS)作为胰岛素分泌指标 ,并对 6组患者的这些指标及临床特征 ,进行对比分析。　结果　与 NGT组比较 ,IFG组 HOMA- IR(1.4 6± 0 .6 0 ,1.0 6± 0 .6 4 ,t=- 6 .716 ,P<0 .0 0 1)、空腹胰岛素 (FINS) (17.90± 10 .0 6 ,15 .79± 10 .94 ,t=- 2 .0 71,P=0 .0 39)增高 ,HB-CI(4.6 5± 0 .6 0 ,5 .2 7± 0 .76 ,t=3.399,P<0 .0 0 1)及 IS(0 .86± 0 .6 0 ,0 .99± 0 .6 2 ,t=2 .36 6 ,p=0 .0 18)降低 ;IGT组 HOMA- IR(1.39± 0 .5 8,t=4 .6 98) ,FINS(2 1.2 7± 15 .39,t=4 .4 93)、2 - h胰岛素(6 0 .84± 37.86 ,t=8.4 82 )、HBCI(5 .4 7± 0 .79,t=2 .6 98)、IS(1.2 5± 0 .6 1,t=4 .0 34,P值均 <0     

糖调节受损个体胰岛β细胞功能和胰岛素抵抗观察

评价152例人选者[正常糖耐量、空腹血糖受损和(或)糖耐量受损]胰岛β细胞功能和胰岛素抵抗.结果 显示空腹血糖受损者主要表现胰岛素早期分泌功能缺陷和基础分泌不足,胰岛素抵抗严重;糖耐量受损者则胰岛素早期和晚期分泌功能显著下降伴轻度胰岛素抵抗.     

新疆汉、维民族糖调节受损人群胰岛素分泌功能和胰岛素作用功能的研究

目的 评估新疆汉、维民族在IFG,IGT及IGR阶段的胰岛素分泌功能和胰岛素作用功能。 方法 采用多中心研究进行横断面调查,行OGTT试验。用胰岛素抵抗指数（HOMA-IR）评估IR,胰岛β细胞功能指数（HOMA-β）评估基础胰岛素分泌;ΔI30/ΔG30评价胰岛素早相分泌,ΔI30/ΔG30/HOMA-IR评估葡萄糖处置指数（DI）。 结果 WC、BMI、血脂、FIns、2 hIns在汉、维民族不同糖代谢组差异有统计学意义。IFG组与NGT、IGT组比较,汉、维族人群的HOMA-IR差异有统计学意义。在汉族中NGT组与IGT、IGR组比较,HOMA-β差异有统计学意义（P=0.030、0.044）,而在维族只有IFG组与NGT组比较差异有统计学意义（P=0.001）。ΔI30/ΔG30、DI在两民族不同糖代谢组差异均无统计学意义。 结论 汉族人群IR在IFG阶段,胰岛素分泌功能在IGT阶段起主要作用。IR和胰岛素分泌功能在维族人群IFG阶段起重要作用。胰岛素早相分泌及葡萄糖处置功能在糖调节受损阶段作用不显著。     

空腹糖耐量受损及空腹血糖偏低和老年人轻度认知障碍的关系探讨

目的探讨轻度认知障碍(MCI)风险与血糖代谢异常的相关性,并为MCI的预防提供依据。方法本研究对1074例认知功能正常且无糖尿病、高脂血症、痛风的老年门诊患者进行了调查。随访5年,根据简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)进行认知功能评估,有121例受试者被诊断出患有MCI。此外,监测受试者每年血糖、糖化血红蛋白。结果入组的1074例受试者根据认知功能的不同分为MCI组和非MCI组,与非MCI组相比,MCI组中空腹血糖(FBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)和总胆固醇(TC)的平均值更高(均P<0.05)。在高血糖组中,FBG的临界值为6.2 mmol/L(敏感性=84.1%,特异性=90.9%,曲线下面积=0.875,P<0.001);在低血糖组中,FBG的临界值为4.5 mmol/L(灵敏性=77.4%,特异性=87.3%,曲线下面积=0.823,P<0.001)。HbA1c的临界值为5.5%(敏感性=76.0%,特异性=87.0%,曲线下面积=0.815,P<0.001)。多元Logistic回归分析MCI的风险增加与空腹血糖平均值<4.5 mmol/L和≥6.2 mmol/L(RR:1.69,95%CI:1.11~2.59;RR:1.81,95%CI:1.15~2.86)以及糖化血红蛋白平均值≥5.5%(RR:2.13,95%CI:1.51~2.99)相关。结论空腹糖耐量受损及空腹血糖偏低是老年人MCI发生风险的独立危险因素。     

糖调节受损人群胰岛素抵抗与胰岛β细胞功能的研究

目的　评价糖调节受损(IGR)人群胰岛素抵抗(IR)与胰岛β细胞功能状态。　方法　(1)从青岛地区流行病学调查资料中,选取正常糖耐量(NGT)者447例;IGR 277例,其中空腹血糖受损(IFG)142例;糖耐量受损(IGT)93例;IFG IGT42例。(2)测身高、体重、腰围、血压及血脂,空腹与糖负荷后血糖、胰岛素。(3)评价IR及基础与糖负荷后早期胰岛素分泌功能。　结果　IGR人群的年龄、血压、体质指数(BMI)、腰围、腰臀比均明显高于NGT人群。而IGT组的年龄、甘油三酯高于IFG组。校正年龄、性别及BMI等因素后,IGR人群HOMA-IR增高(P<0.05), IFG、IGT及IFG IGT组间无差异;IFG与IFG IGT组的HOMA-β明显低于NGT和IGT组(P<0.01); IGT组△I30/△G30 低于NGT(P<0.05)。Logistic回归分析显示,年龄、BMI、HOMA IR及HOMA β与IFG的发生密切相关(P<0.01),年龄、BMI、△I30/△G30则与IGT的发生相关(P<0.05)。　结论　IGR人群存在IR,同时IFG基础状态下胰岛β细胞功能轻度受损,而IGT人群的早期胰岛素分泌反应减弱。     

Men with impaired glucose tolerance have lower self-rated health than men with impaired fasting glucose

AimPrevious studies have shown that individuals with impaired glucose tolerance (IGT) have lower self-rated health than normoglycaemic individuals. The aim of this study was to examine differences in self-rated health between individuals with IGT and those with impaired fasting glucose (IFG) and to consider the potentially mediating effect of physical activity.MethodsIn 2002–2005, a total of 2816 individuals were randomly selected for a population-based study in Sweden. All participants performed an oral glucose tolerance test (OGTT). Fasting venous blood samples were drawn, and questionnaires concerning lifestyles were completed. Self-rated health (SRH) and leisure time physical activity (LTPA) were reported on a five-graded and four-graded scale, respectively. A total of 213 individuals with IGT and 129 with IFG were detected.ResultsIGT, but not IFG, was associated with low self-rated health. The difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR = 2.13, CI: 1.13–4.02, p = 0.020). The results became insignificant when including physical activity in the model (OR = 1.8, CI: 0.91–3.58, p = 0.094).ConclusionThe low self-rated health adds further weight to the risk profile in men with IGT and stresses the importance of early detection and lifestyle interventions.     

空腹血糖受损、糖耐量受损人群3年自然转归及其影响因素的研究

目的 探讨空腹血糖受损(IFG)、糖耐量受损(IGT)人群发生糖尿病的危险性及其影响因素. 方法对2003年4～6月朝阳市市区居民1 062人糖尿病普查中IFG、IGT患者79人于2006年4～6月进行随访调查.测量身高、体重、腰围、血压,做过夜空腹75g葡萄糖耐量试验,同时测定血总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C).结果 随访的65人中22人发生糖尿病.其中孤立性IFG(I-IFG)糖尿病转变率为10.8%,孤立性IGT(I-IGT)为9.2%, IFG/IGT为10.4%.在不同的年龄组,随着年龄增长糖代谢异常、高血压、肥胖、脂代谢异常有增加趋势,在40岁以上人群糖代谢异常的患病率有明显增加趋势.进行单因素相关分析结果发现血糖升高可能与增龄、糖尿病(DM)家族史、劳动强度、腰围指数(WC)增加、收缩压(SBP)增加、血脂异常等相关.进行Logistic回归分析,高龄、血压升高、中心性肥胖、体力活动强度减弱均为糖尿病危险因素.结论 I-IGT、IGT/IFG人群糖尿病累计发病率明显高于I-IFG人群.增龄、向心性肥胖、高血压、体力活动减少是糖代谢异常的重要危险因素,因此控制血压、体重,增加体力活动,对糖尿病预防具有重要意义.     

Insulin secretory capacity and insulin sensitivity in impaired fasting glucose in Japanese

Aims/Introduction: Impaired fasting glucose (IFG) increases the risk of developing diabetes mellitus (DM). This study was carried out to characterize Japanese patients who have fasting glucose levels (FPG) between 100 and 109 mg/dL (IFG_100–109). Materials and Methods: A total of 1383 Japanese participants were examined by oral glucose tolerance test. We compared insulin secretory capacity (insulinogenic index) and insulin sensitivity (ISI composite) of IFG_100–109/normal glucose tolerance (NGT; 100 ≤ FPG < 110 mg/dL and 2‐h postchallenge glucose level (2‐hPG) < 140 mg/dL) with NGT (100 mg/dL < FPG and 2‐hPG < 140 mg/dL) and IFG_110–125/NGT (110 ≤ FPG < 126 mg/dL and 2‐hPG < 140 mg/dL). In addition, IFG_100–109 patients were analyzed in three subgroups according to glucose intolerance by 2‐hPG. Results: Of the three categories of IFG_100–109, IFG_100–109/DM had the lowest insulinogenic index despite an ISI composite showing only a small decline from IFG_100–109/NGT through IFG_100–109/IGT (100 ≤ FPG < 110 mg/dL and 140 ≤ 2‐hPG < 200 mg/dL) to IFG_100–109/DM (100 ≤ FPG < 110 mg/dL and 200 mg/dL < 2‐hPG). By multiple regression analysis, the insulinogenic index showed a significant relationship with 2‐h PG levels. Both insulinogenic index and ISI composite were decreased significantly from NGT through IFG_100–109/NGT to IFG_110–125/NGT. Conclusions: Although impaired early‐phase insulin secretion plays the more important role in the elevation of postchallenge glucose in IFG_100–109 patients, both impaired early‐phase insulin secretion and decreased insulin sensitivity are involved in the deterioration of FPG in Japanese. In addition, insulin secretory defect and decreased insulin sensitivity already have begun in patients with IFG_100–109. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00201.x, 2012)     

空腹血糖受损诊断标准下调的合理性分析

目的　探讨空腹血糖受损 (IFG)诊断点从 6.1mmol/L下调至 5 .6mmol/L的合理性。方法对1986年入选的 468名非糖尿病人群〔3 41例正常糖耐量 (NGT) ,12 7例糖耐量受损 (IGT)〕在 1988年 ,1990年和 1992年分别进行OGTT复查 ,测定空腹血糖 (FPG)及 2h血糖 (2hPG)。以COX模型分析不同基线血糖水平增加糖尿病的风险。结果　 (1) 10 9例 6年后发生糖尿病。COX成比例风险模型分析校正年龄、性别、体重指数 (BMI)影响后发现FPG与 2型糖尿病发病显著相关 (P =0 .0 0 0 1)。基线FPG 5 .6～ 6.0mmol/L组糖尿病发病危险性比FPG <5 .6mmol/L组已显著增加 ,RR为 3 .3 (95 %CI 2 .0～ 5 .3 ,P =0 .0 0 0 1)。 (2 )受试者工作特征 (ROC)曲线分析FPG预测糖尿病发病的最佳阈值是 5 .6mmol/L ,以FPG 5 .6mmol/L为诊断点IFG预报糖尿病发病的灵敏度、特异度、阳性预测值分别为 45 .0 % ,92 .8%和 65 .3 %。 (3 )NGT个体中COX成比例风险模型校正年龄、性别、BMI后显示 ,FPG分组 (5 .0～ 6.0mmol/L与 <5 .0mmol/L)与糖调节受损 (IGR ,包括IFG或IGT)发生显著正相关 (P =0 .0 0 7)。ROC曲线显示 ,FPG预测糖耐量恶化而进展为DM或IGR的最佳阈值为 5 .3mmol/L。结论　 (1)本组非糖尿病人群中FPG预测糖尿病发病的最佳阈值为 5 .6mmol/L     

上海地区肥胖糖调节受损者的胰岛素敏感性和1相胰岛素分泌功能研究

目的研究上海地区肥胖的糖调节受损(IGR)者胰岛素敏感性和胰岛β细胞1相胰岛素分泌功能。方法共有129例受试者[非肥胖正常对照38名,IGR包括单独糖耐量受损(IGT)64例,单独空腹血糖受损(IFG)8例,IFG+IGT 19例]接受了口服75g葡萄糖耐量试验和胰岛素改良的减少样本数(n =12)的Bergman微小模型技术结合频繁采血的静脉葡萄糖耐量试验(FSIGTT)。胰岛素抵抗由FSIGTT中胰岛素敏感性指数(S1)加以评估,而FSIGTT中对葡萄糖急性胰岛素分泌反应(AIRg)则用以评价胰岛β细胞分泌功能。处理指数(DI=AIRg×S1)用于评价AIRg是否代偿机体的胰岛素抵抗。结果(1)与正常对照组相比,3组IGR患者之S1明显降低(均P<0．01),3组差异无统计学意义;(2)AIRg在正常组和IGT组之间差异无统计学意义,但均大于IFG和IFG+IGT组,差异有统计学意义(P<0．05或JP<0．01)。IFG +IGT组的AIRg值显著低于IGT组(P<0．01);(3)与正常组相比,DI指数在3组IGR显著降低(P< 0．01),但在IGR组间差异无统计学意义;(4)S1与空腹胰岛素、体重指数、血清尿酸呈显著负相关(校正r2 =0．568,P<0．01);而AIRg与2h胰岛素显著正相关,与空腹血糖、2h血糖和年龄负相关(校正r2=0．402, P<0．01)。结论上海地区肥胖的初诊IGR患者(包括单独IGT、单独IFG和IFG+IGT患者)存在着程度近似的胰岛素抵抗;急性相胰岛素分泌功能在校正胰岛素抵抗影响因素后IGT患者尚属正常,在IFG和IFG+IGT患者已明显降低,且3组的β细胞代偿功能均为一致性失代偿。     

Impaired fasting glycaemia vs impaired glucose tolerance: similar impairment of pancreatic alpha and beta cell function but differential roles of incretin hormones and insulin action

Aims/hypothesis The impact of strategies for prevention of type 2 diabetes in isolated impaired fasting glycaemia (i-IFG) vs isolated impaired glucose tolerance (i-IGT) may differ depending on the underlying pathophysiology. We examined insulin secretion during OGTTs and IVGTTs, hepatic and peripheral insulin action, and glucagon and incretin hormone secretion in individuals with i-IFG (n = 18), i-IGT (n = 28) and normal glucose tolerance (NGT, n = 20). Methods Glucose tolerance status was confirmed by a repeated OGTT, during which circulating insulin, glucagon, glucose-dependent insulinotrophic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) levels were measured. A euglycaemic–hyperinsulinaemic clamp with [3–³H]glucose preceded by an IVGTT was performed. Results Absolute first-phase insulin secretion during IVGTT was decreased in i-IFG (p = 0.026), but not in i-IGT (p = 0.892) compared with NGT. Hepatic insulin sensitivity was normal in i-IFG and i-IGT individuals (p ≥ 0.179). Individuals with i-IGT had peripheral insulin resistance (p = 0.003 vs NGT), and consequently the disposition index (DI; insulin secretion×insulin sensitivity) during IVGTT (DI_IVGTT)) was reduced in both i-IFG and i-IGT (p < 0.005 vs NGT). In contrast, the DI during OGTT (DI_OGTT) was decreased only in i-IGT (p < 0.001), but not in i-IFG (p = 0.143) compared with NGT. Decreased levels of GIP in i-IGT (p = 0.045 vs NGT) vs increased levels of GLP-1 in i-IFG (p = 0.013 vs NGT) during the OGTT may partially explain these discrepancies. Basal and post-load glucagon levels were significantly increased in both i-IFG and i-IGT individuals (p ≤ 0.001 vs NGT). Conclusions/interpretation We propose that differentiated preventive initiatives in prediabetic individuals should be tested, targeting the specific underlying metabolic defects.     

空腹血糖受损、糖耐量受损人群2年自然转归及其影响因素的研究

目的探讨空腹血糖受损(IFG)、糖耐量受损(IGT)人群发生糖尿病的危险性及其影响因素.方法对1999年7月～12月包钢集团公司2万余人糖尿病普查中IFG、IGT患者730人于2001年9～11月进行随访调查.测量身高、体重、腰围、血压,作过夜空腹75 g葡萄糖耐量试验,同时测定空腹胰岛素(FINS)及服糖后2 h胰岛素(PINS),血总胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C).结果随访的656人中138人发生糖尿病.其中孤立性IFG(I-IFG)糖尿病年转变率为5.1%,孤立性(I-IGT)为11.5%,IGT为14.0%,IFG/IGT为20.2%.I-IGT、IGT及IFG/IGT糖尿病年转变率明显高于I-IFG(均P＜0.001).与I-IFG比较,I-IGT发生糖尿病的危险比为2.65,IFG/IGT为5.96.I-IFG转归为糖尿病的危险因素主要是年龄(OR 1.05)和BMI(OR 1.03).I-IGT是2h血糖(OR 2.02)、家族史(OR 2.19)及腰围(OR 1.08).各项临床指标2年的变化结果转归为I-IFG、I-IGT者2年前后的年龄、体重、腰围、BMI、血压、TC均值及其肥胖、腹型肥胖、血脂代谢紊乱、高血压的患病率均比NGT转归组高;I-IFG与I-IGT比较差异无显著性.结论 I-IGT发生糖尿病的危险性明显高于I-IFG,主要危险因素为腰围、餐后血糖、家族史.I-IFG发生糖尿病的危险因素则是年龄、BMI.故对IGT应给予积极的干预治疗,而对于IFG应定期随访.     

空腹血糖受损切点下调后对上海浦东社区人群糖调节受损分布的影响

上海浦东20岁以上人口75gOGTT筛查研究发现，IFG，IGT，IFG合并IGT的患病率，应用FPG〉6．1mmol／L诊断IFG的旧标准时分别为2．60％，3．24％，0．75％；应用FPG〉5．6mmol／L诊断IFG的新标准时分别为6．25％，2．56％，1．43％。     

糖耐量减退及空腹血糖异常患者血清载脂蛋白B、AI检测及其临床意义

目的　探讨糖耐量低减 (IGT)及空腹血糖异常 (IFG)患者血清载脂蛋白B(ApoB)及载脂蛋白AI(ApoAI)水平的变化。 方法　分三组进行研究 ,IGT组 5 8例 ,IFG组 5 5例 ,6 4例血糖正常者为对照组。分别检测其甘油三脂 (TG)、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL c)、高密度脂蛋白胆固醇 (HDL c)、脂蛋白 (a) [LP(a) ]、载脂蛋白B(ApoB)、载脂蛋白AI(ApoAI)、空腹血糖 (FPG)、糖化血红蛋白 (HbA1c)、C 肽 (C P)、胰岛素 (Ins)及体重指数 (BMI) ,间隔 2周共检测 4次。结果　IGT及IFG患者LDL c、LP(a)、ApoB水平较对照组高 ,HDL c、ApoAI及ApoAI/ApoB水平较对照组低 ,其中ApoB升高及HDL c、ApoAI/ApoB、ApoAI降低与对照组比较差异有显著性 (P <0 .0 1) ,且IGT组ApoB较IFG组明显升高 ( P <0 .0 1)。ApoB及ApoAI与HbA1c、C P、Ins及BMI水平比较无明显相关 (P >0 .0 5 )。结论　IGT及IFG患者的脂代谢紊乱以ApoB升高及ApoAI降低为主 ,这可能是 2型糖尿病患者动脉粥样硬化的重要危险因素。     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.     

Oral glucose tolerance test‐based calculation identifies different glucose intolerance phenotypes within the impaired fasting glucose range

Aims/Introduction

The conventional oral glucose tolerance test (OGTT) cannot detect future diabetics among isolated impaired fasting glucose (is‐IFG) nor normal glucose tolerant (NGT) groups. By analyzing the relationship between fasting (FPG) and 2‐h plasma glucose (2hPG), the present study identifies is‐IFG subjects liable to worsening glucose homeostasis.

Materials and Methods

Oral glucose tolerance test was carried out in 619 patients suffering from obesity, hypertension or dyslipidemia, whose FPG was in the 100–125 mg/dL range. We calculated the percentage increment of 2hPG with respect to FPG (PG%) in these patients using the formula: ([2hPG − FPG] / FPG) × 100. Differences in β‐cell function within is‐IFG patients were assessed by estimated insulin sensitivity index (EISI), first‐phase insulin release (1stPH) and 1stPH/1/EISI (1stPH_corrected).

Results

Diabetes was diagnosed in 69 patients (11.2%), combined IFG/impaired glucose tolerance (IGT) in 185 patients (29.9%) and is‐IFG in 365 patients (58.9%). Is‐IFG was subdivided into PG% tertile groups: the percentage of females increased from 25% in the lowest to 45.2% in the highest tertile (χ² = 18.7, P < 0.001). Moving from the lowest to the highest PG% tertile group, insulin and 2hPG concentrations rose, whereas FPG, EISI, and 1stPH_corrected decreased progressively and significantly. Furthemore, PG% correlated inversely with EISI (r = −0.44, P < 0.0001) and 1stPH_corrected (r = −0.38, P < 0.0001).

Conclusions

Oral glucose tolerance test does differentiate the great heterogeneity in metabolic disorders of patients with FPG 100–125 mg/dL. Furthermore, PG% can expand the diagnostic power of OGTT in the is‐IFG range by distinguishing metabolic phenotypes very likely to herald different clinical risks.     

空腹血糖受损诊断标准下调对糖调节受损人群检出率的影响

目的 分析空腹血糖受损（IFG）的空腹血糖（FPG）诊断标准下调对糖调节受损（IGR）人群检出率的影响，并探讨区分糖调节正常与受损的FPG理想截定点。方法 对2882例无2型糖尿病（T2DM）史的受试者进行口服葡萄糖耐量试验。采用1997年和2003年美国糖尿病学会分类诊断标准进行比较。结果 （1）IFG诊断标准下调后，单纯IFG者增加367例，IFG者由424例增加到1032例，其中包含的糖耐量受损（IGT）者由243例增加到484例；709例IGT者，包括在IFG者中的比例由34％上升到68％。（2）与糖耐量正常（NGT）人群相比，新增单纯IFG人群体质指数、FPG、2hPG、糖化血红蛋白、甘油三酯、胆固醇均升高（均P＜0．01），超重（52．6 vs 39．7％，χ^2=6．79，P〈0．01）和高甘油三酯血症发生率（32．2％ vs 24．9％，；χ^2=3．98，P〈0．05）明显增高。（3）非T2DM人群中诊断IGR（7．8≤2hPG＜11．1mmol／L）的FPG理想截定点为5．6mmol／L。结论 IFG诊断标准下调后，IFG、IFG＋IGT检出率明显增加；新增单纯IFG人群已经出现糖、脂代谢异常；非T2DM人群中诊断IGR的FPG理想截定点为5．6mmol／L。