空腹血糖受损切点变化与糖尿病及心脑血管事件风险的关系--上海华阳社区40岁以上人群的随访研究

目的　比较 1999年世界卫生组织 (WHO)及 2 0 0 3年美国糖尿病协会 (ADA)标准诊断的空腹血糖受损 (IFG)与糖尿病和心脑血管事件发生风险的关系 ,从而探讨中国人IFG切点下调的合理性。方法　对 1999年上海华阳社区 40岁以上代谢综合征及其相关疾病 (糖尿病、高血压、肥胖、血脂紊乱 )的横断面调查人群在 2 0 0 2～ 2 0 0 4年进行随访。随访对象接受了 75g葡萄糖耐量试验 ,并检测血糖、血脂、胰岛素、血压、体重指数、腰围与腰臀比等。调查了心脑血管事件发生情况。结果　 (1)基线资料中无糖尿病人群共170 4例 ,完成随访 12 92例。 3年糖尿病累积发生率为 4.64 % ,年发病率 1.5 5 %。 (2 )正常糖调节及糖调节受损人群的糖尿病年发病率分别为 0 .97%及 6.97%。 (3 )随访空腹血糖 (FPG) 5 .6～ 6.0mmol/L、6.1～ 6.9mmol/L而餐后 2h血糖 (2hPG) <7.8mmol/L的人群见到发生糖尿病的风险分别增加 3 .71及 2 8.12倍 (P <0 .0 0 1) ,但未见到发生心脑血管事件的风险显著增加。 (4 )在FPG <5 .6mmol/L且 2hPG 7.8～ 11.0mmol/L人群中 ,发生糖尿病及心脑血管事件的相对风险分别显著增加 4.3 1及 3 .40倍 (P <0 .0 0 1)。结论　FPG 5 .6～ 6.0mmol/L的人群发生糖尿病的风险显著增加 ,将空腹血糖受损的下限调整至 5 .

Alteration of cut-point of impaired fasting glucose on the risk of cardiocerebrovascular events--a follow-up study in subjects aged over 40 years in Shanghai Huayang community

Objective To compare the relationship between impaired fasting glucose, which is diagnosed according to the WHO criteria (1999) or the recommendation that American Diabetes Association (ADA) suggested in 2003, and the risk of developing diabetes and cardiocerebrovascular events, as well as to investigate the feasiblility of lowering the cut-point of impaired fasting glucose (IFG) from 6.1 mmol/L to 5.6 mmol/L in Chinese. Methods From 2002 to 2004, we conducted a follow-up survey on the subjects aged over 40 years in Shanghai Huayang community, who received the cross-sectional analysis on metabolic syndrome and its components diabetes, hypertension, obesity, dyslipidemia in 1999. BMI, waist circumference, waist-to-hip ratio and blood pressure were measured;75 g glucose tolerance test, fasting insulin and lipid profile were performed in all subjects who participated this follow-up survey. In addition, the questionnaires on the incidence of cardiovascular events were completed. Results (1) Of 1704 subjects without diabetes in the baseline survey, 1292 of them attended this follow-up examination. Three-year cumulative incidence of diabetes was 4.64%, and the annual incidence was 1.55%. (2) In those subjects with normal glucose tolerance and impaired glucose regulation, the annual incidence of diabetes was 0.97% and 6.97% respectively. (3) Among the subjects with fasting plasma glucose (FPG) 5.6-6.0 mmol/L and 2 h postprandial plasma glucose (2hPG)<7.8 mmol/L, and FPG 6.1-6.9 mmol/L and 2hPG<7.8 mmol/L, the risk of diabetes increased 3.71 times and 28.12 times (all P<0.001) respectively, but the risk of cardiovascular events did not rise significantly. (4) Among the subjects with FPG<5.6 mmol/L and 2hPG 7.8-11.0 mmol/L, the risk of diabetes increased 4.31 times (P<0.001), along with the risk of cardiovascular events increased 3.4 times (P <0.001). Conclusion Theriskofdevelopingdiabetes in those subjects with FPG of 5.6-6.0 mmol/L markedly increased. Decreasing the lower limit of IFG to 5.6 mmol/L will be advantageous to the prevention of diabetes.