Association between a deletion/insertion polymorphism in the α2B-adrenergic receptor gene and insulin secretion and Type 2 diabetes. The Finnish Diabetes Prevention Study

Aims/hypothesis Impaired insulin secretion has a strong genetic component. In this study we investigated whether the 12Glu9 polymorphism in the gene encoding the 2B-adrenergic receptor (ADRA2B) is associated with insulin secretion and/or the incidence of Type 2 diabetes in individuals with impaired glucose tolerance.Methods We investigated a total of 506 subjects with impaired glucose tolerance participating in the Finnish Diabetes Prevention Study (DPS). Participants were randomly assigned to an intervention group or a control group. Anthropometric measurements and an oral glucose tolerance test were performed at baseline and at annual follow-up. In a subgroup of patients (n=83), a frequently sampled intravenous glucose tolerance test (FSIGT) was performed at baseline.Results All patients had similar anthropometric measurements and insulin and glucose levels at baseline. Multiple logistic regression analysis revealed significant interaction (p=0.003) between study group and genotype across the entire study population. In the control group, subjects with the Glu9 allele had an increased risk of developing Type 2 diabetes compared with subjects with the Glu12/12 genotype (odds ratio [OR]=2.68, 95% CI 1.02–7.09, p=0.047 for Glu12/12, and OR=5.17, 95% CI 1.76–15.21, p=0.003 for Glu9/9). This increased risk was not observed in the intervention group, who showed significant weight loss during the trial. In the subgroup who underwent the FSIGT, subjects with the Glu9/9 genotype showed the lowest acute insulin response (p=0.005 for trend).Conclusions/interpretation The 12Glu9 polymorphism of ADRA2B is associated with impaired first-phase insulin secretion and may predict the development of Type 2 diabetes in subjects with impaired glucose tolerance who are not subjected to a lifestyle intervention.Abbreviations AIR acute insulin response - AR adrenergic receptor - BMR basal metabolic rate - DI disposition index - DPS the Finnish Diabetes Prevention Study - FSIGT frequently sampled intravenous glucose tolerance test - OR odds ratio - S_G glucose effectiveness - S_I insulin sensitivity index     

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。     

对采用空腹指尖毛细血管血血糖筛查糖尿病和糖耐量减低偏性的研究

目的探讨采用空腹指尖毛细血管血血糖（FBG）≥6．1mmol／L作为界定值筛查糖尿病（DM）和糖耐量减低（IGT）出现的偏性。方法筛查设A、B、C、D四个自然人群组。各组分别为8151、9168、9096及8355人。A、B、C三组均先做FBG，其界定值依次为6，1mol／L、55mol／L、5，0mol／L，各组超过或等于其界定值者再做OGTT，筛查DM和IGT。D组则直接做OGTT筛查DM和IGT。DM和IGT诊断按照WHO1999年标准。结果A、B、C、D四组DM的检出率分别为6．91％、8．21％、8．30％、8．32％，IGT的检出率分别为2．48％、6.10％、8．05％、8．16％。A组行OGTT的人数比例占被调查总人群的11．3％，与D组比较，DM、IGT漏检率分别为16，95％、69，61％；B组行OGTT的人数比例占被调查总人群的27．79％，与D组比较，DM、IGT漏检率分别为1.32％和25．25％；C组行OGTT的人数比例占被调查总人群的58．37％，与D组比较，DM、IGT漏检率分别为0．24％和1．35％。结论选择FBG≥5．0mmol／L作为界定值，是开展糖尿病流行病学调查获得DM和IGT患病率的成本-效益-效果最佳方案。     

糖调节受损人群发病特点和临床特征分析

目的分析糖调节受损(IGR)人群的发病特点和临床特征。方法将1994年全国糖尿病协作组调查资料库中≥25岁12085例经口服75g葡萄糖耐量试验(OGTT)的中国成年人分为糖耐量正常(NGT)组、空腹血糖受损(IFG)组、糖耐量低减(IGT)组、IFG和IGT并存(IFG/IGT)组。比较各组在不同性别、不同年龄段中的分布状况以及临床特点。结果在IFG组、IFG/IGT组,男性发病比例高于女性;在IGT组,男女比例差异无显著性意义。IGT组和IFG/IGT组分布频率均随年龄增加而增高,IGT组高峰在>65岁段,IFG/IGT组高峰在55~65岁段。IFG组在各年龄段分布频率接近,随年龄增加的趋势不明显,在25~34岁段比例高于IGT组。IFG、IGT、NGT组间比较,多项临床指标差异有显著性意义。IFG/IGT组与其他组比较变化趋势更为明显。结论IFG和IGT人群在性别和年龄上发病特点不同。IGT具有比IFG更强的致心血管疾病危险性。当IFG和IGT并存时,致心血管疾病的危险性更大。     

非肥胖糖耐量减低患者的非酒精性脂肪肝与胰岛素抵抗的相关性

对40例非肥胖的糖耐量减低（IGT）者伴非酒精性脂肪肝（NAFL）与40例非肥胖IGT者不伴NAFL的研究显示，非肥胖的IGT伴NAFL患者有更显著的胰岛素抵抗，而且在非肥胖的IGT者中，胰岛素抵抗是NAFL的独立危险因素。     

Impaired glucose tolerance in midlife and longitudinal changes in brain function during aging

We investigated whether individuals with impaired glucose tolerance (IGT) in midlife subsequently show regionally specific longitudinal changes in regional cerebral blood flow (rCBF) relative to those with normal glucose tolerance (NGT). Sixty-four cognitively normal participants in the neuroimaging substudy of the Baltimore Longitudinal Study of Aging underwent serial ¹⁵O-water positron emission tomography scans (age at first scan, 69.6 ± 7.5 years) and oral glucose tolerance tests 12 years earlier (age at first oral glucose tolerance test, 57.2 ± 11.1 years). Using voxel-based analysis, we compared changes in rCBF over an 8-year period between 15 participants with IGT in midlife and 49 with NGT. Significant differences were observed in longitudinal change in rCBF between the IGT and NGT groups. The predominant pattern was greater rCBF decline in the IGT group in the frontal, parietal, and temporal cortices. Some brain regions in the frontal and temporal cortices also showed greater longitudinal increments in rCBF in the IGT group. Our findings suggest that IGT in midlife is associated with subsequent longitudinal changes in brain function during aging even in cognitively normal older individuals.     

体验式饮食管理在糖调节受损患者中的应用效果

目的 探讨体验式饮食管理在糖调节受损患者中的应用效果。方法 选取2018年1—6月笔者所在医院糖尿病门诊的120例患者,采用随机数字表法将所有患者分为对照组和观察组,各60例。比较2组空腹血糖、餐后2h血糖、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇以及患者自我管理能力。结果 干预3个月后,观察组的空腹血糖、餐后2h血糖、糖化血红蛋白,三酰甘油均低于对照组(t=5.523,P<0.001;t=4.280,P<0.001;t=2.970,P=0.004;t=3.478,P=0.001)。患者糖尿病前期自我管理量表得分明显高于对照组(t=-10.357,P<0.001)。2组总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇比较,差异无统计学意义(P＞0.05)。结论 体验式饮食管理能有效控制糖调节受损患者的血糖水平以及部分血脂指标水平,同时提高了患者的饮食自我管理能力,对糖调节受损患者的饮食指导具有良好的意义。     

Improved fibrinolysis by an intensive lifestyle intervention in subjects with impaired glucose tolerance. The Finnish Diabetes Prevention Study

Aims/hypothesis The aim of this study was to investigate the effects of lifestyle intervention on the levels of plasminogen activator inhibitor (PAI-1) and fibrinogen in subjects participating in the Finnish Diabetes Prevention Study (DPS).Methods In five DPS centres, 321 subjects with impaired glucose tolerance (intervention group, n=163; control group, n=158) had their PAI-1 and fibrinogen levels measured at baseline and at the 1-year follow-up. Additional 3-year follow-up assessments were carried out in a sample of 97 subjects in one of the DPS centres (Turku). The intervention programme included an intensive lifestyle intervention aiming at weight reduction, healthy diet and increased physical activity.Results During the first intervention year, PAI-1 decreased by 31% in the intervention group but showed no change in the control group (p<0.0001). In the Turku subgroup, the decrease in PAI-1 persisted throughout the 3-year follow-up. Changes in PAI-1 were associated with the number of lifestyle changes made during the first year (p=0.008). Weight reduction was the most important factor explaining the decrease in PAI-1. Changes in fibrinogen levels did not differ between the groups.Conclusions/interpretation In addition to the previously reported reduction in the risk of type 2 diabetes in DPS participants with impaired glucose tolerance, the intensive dietary and exercise intervention had beneficial long-term effects on fibrinolysis as indicated by the reduced levels of PAI-1. These results suggest that elevated PAI-1 levels in obese subjects with impaired glucose tolerance are mostly reversible by lifestyle changes, especially those geared to weight reduction.     

Fasting proinsulin and 2-h post-load glucose levels predict the conversion to NIDDM in subjects with impaired glucose tolerance: The Hoorn Study

Summary The aims of the present study were to observe the natural history of impaired glucose tolerance and to identify predictors for development of non-insulin-dependent diabetes mellitus (NIDDM). A survey of glucose tolerance was conducted in subjects aged 50–74 years, randomly selected from the registry of the middle-sized town of Hoorn in the Netherlands. Based on the mean values of two oral glucose tolerance tests subjects were classified in categories of glucose tolerance according to the World Health Organization criteria. All subjects with impaired glucose tolerance (n=224) were invited to participate in the present study, in which 70% (n=158) were subsequently enrolled. During follow-up subjects underwent a repeated paired oral glucose tolerance test. The mean follow-up time was 24 months (range 12–36 months). The cumulative incidence of NIDDM was 28.5% (95% confidence interval 15–42%). Age, sex, and anthropometric and metabolic characteristics at baseline were analysed simultaneously as potential predictors of conversion to NIDDM using multiple logistic regression. The initial 2-h post-load plasma glucose levels and the fasting proinsulin levels were significantly (p<0.05) related to the incidence of NIDDM. Anthropometric characteristics, the 2-h post-load specific insulin levels and the fasting proinsulin/fasting insulin ratio were not related to the incidence of NIDDM. These results suggest that beta-cell dysfunction rather than insulin resistance plays the most important role in the future development of diabetes in a high-risk Caucasian population.Abbreviations IGT Impaired glucose tolerance - NIDDM non-insulin-dependent diabetes mellitus - OGTT oral glucose tolerance test - CI confidence interval - W/H ratio waist/hip ratio - BMI body mass index - OR odds ratio