摘要
目的观察胰岛素抵抗及胰岛素分泌对糖耐量低减（IGT）人群中生活方式干预的预防糖尿病效果的影响。方法大庆地区糖尿病普查中经OGTT确诊的284例IGT，在初访时测量血浆胰岛素，进行饮食、运动或饮食加运动来预防糖尿病的干预治疗6年。分析生活方式干预的治疗效果及胰岛素抵抗、胰岛素分泌对它的影响。结果各干预治疗组之OGTT各时间点的血糖水平均与对照组无明显差别，但各干预治疗组6年的糖尿病发病率均低于对照组。干预组中胰岛素抵抗较轻者（IAI≥一4．73，即FPG×FINS≤114）干预治疗后糖尿病发病率明显低于胰岛素抵抗较严重者（IAI＜一4．73，即FPG×FINS≥114），糖尿病100人年发病率比相应未干预治疗组下降，前者为44％，后者为29％（P＜O．05）。将上述胰岛素抵抗较轻、较重的两组再各自分为β细胞胰岛素分泌较好和较差组，则干预治疗使胰岛素敏感、β细胞功能较好组之糖尿病发病率比对照组下降49％，而在胰岛素抵抗较严重、β细胞功能较差组仅下降27％（P＜0．05）。结论①胰岛素抵抗及β细胞功能可能影响糖尿病干预治疗的效果，胰岛素抵抗严重者单纯生活方式干预效果较差，可能需其它形式治疗。②以简单指数评估胰岛素抵抗和β细胞功能，然后进行分组，选择不同的干预治疗方法，可能有利于提高?
Objective' To investigate the effects of insulin resistance (IR) and insulin secretion (IS) on thedevelopment of diabetes mellitus in individuals with impaired glucose tolerance (IGT) who underwent lif-estyleinterventions. Methods 284 individuals with IGT identified by population-based screening in Da Qing were undergo dietchange and/or increased physical activity. They were followed for six years for the development of diabetes. Theinteraction of IR, IS and the effects of the life--style intervention were evaluated. Results Groups divided at the medianof IAI{l/FPGXFINS)jrepresent the upper and lower halves of the distribution of IR. The more resistant subjects hada higher incidence of DM. The intervention was significantly more effective in the less insulin resistant subjects. Toassess whether the effect of intervention varied according to the extent of both insulin sensitivity and secretion atbaseline, the subjects with IGT were then stratified into four groups by IAI and FBCI(FINS/FPG). Group l:representsthe subjects who were less insulin resistant and had higher insulin secretion. Group 2:were less insulin resistant but hadlower insulin secretion. Group 3: had lower insulin resistant and higher insulin secretion. Group 4: had more insulinresistant and lower insulin secretion. The effect of life-style intervention was greatest in the less insulin resistant groups(groups 1 and 2) with an approximately 50M decrease in the incidence of DM, whereas in groups 3 and 4 hadapproximately 30% decrease in incidence as compared to the corresponding controls. Conclusion @ Both insulinresistance and 9 cell function were predictors of diabetes in Chinese with IGT. Life--style intervention reduced theincidence of DM and these interventions were less effective in those with more insulin resistance who might benefit fromsome additional intervention. AIR and iS evaluation with some simple indices might be useful indefining optimalstrategies for diabetes prevention and may improve the effectiveness and reduce the cost.
出处
《中国糖尿病杂志》
CAS
CSCD
1999年第3期131-134,共4页
Chinese Journal of Diabetes
关键词
糖尿病
干预
治疗
胰岛素抵抗
胰岛素分泌
Diabetes Intervention insulin-resistance insulin--secretion
