CAJ | 학술논문

目的探讨长期综合干预2型糖尿病(T2DM)患者糖代谢的转归及影响因素.方法对129例初诊T2DM患者进行为期6年的综合干预,定期随访,监测体重指数(BMI)、腰臀比(WHR)、血压、血脂、空腹血糖(FPG)及餐后2小时血糖(2hPG)、糖化血红蛋白(HbA1c)及空腹胰岛素(FIns),计算胰岛素敏感指数(ISI)及胰岛素抵抗指数(HOMA-IR).随访结束时行75g 口服葡萄糖耐量试验(OGTT),据此将患者分为DM组和非DM (NDM) 组,后者包括正常糖耐量(NGT)、糖耐量受损(IGT)、空腹血糖受损(IFG)及IGT+IFG,分析DM的转归及影响因素.结果 (1)129例T2DM患者6年后有14例(10.9%)转变为NGT,27(20.9%)例转变为IGT、IFG或IGT+IFG,88例(68.2%)仍为DM.(2)NDM组基线时FPG、WHR、甘油三酯(TG)低于DM组;终点时WHR、HbA1c、FPG、2hPG水平低于DM组,高密度脂蛋白胆固醇(HDL-C)高于DM组;两组治疗后BMI、HDL-C的变化值(△BMI、△HDL-C)差异有统计学意义.(3)基线时两组OGTT试验各点胰岛素水平、HOMA-IR及ISI无显著性差异,终点时NDM组OGTT试验0.5h、1h胰岛素水平及ISI高于DM组,HOMA-IR低于DM组;与DM组相比,NDM组治疗后胰岛素的敏感性明显改善.(4)Logistic回归显示OGTT 0.5h胰岛素与DM的缓解呈独立正相关,△HOMA-IR、△BMI与DM的缓解呈独立负相关.结论 (1)长期综合干预可使相当多的T2DM患者获得缓解.(2)控制体重、减轻胰岛素抵抗、恢复早相胰岛素分泌是DM长期缓解的重要因素.
목적 탐토장기종합간예2형당뇨병(T2DM)환자당대사적전귀급영향인소.방법 대129례초진T2DM환자진행위기6년적종합간예,정기수방,감측체중지수(BMI)、요둔비(WHR)、혈압、혈지、공복혈당(FPG)급찬후2소시혈당(2hPG)、당화혈홍단백(HbA1c)급공복이도소(FIns),계산이도소민감지수(ISI)급이도소저항지수(HOMA-IR).수방결속시행75g 구복포도당내량시험(OGTT),거차장환자분위DM조화비DM (NDM) 조,후자포괄정상당내량(NGT)、당내량수손(IGT)、공복혈당수손(IFG)급IGT+IFG,분석DM적전귀급영향인소.결과 (1)129례T2DM환자6년후유14례(10.9%)전변위NGT,27(20.9%)례전변위IGT、IFG혹IGT+IFG,88례(68.2%)잉위DM.(2)NDM조기선시FPG、WHR、감유삼지(TG)저우DM조;종점시WHR、HbA1c、FPG、2hPG수평저우DM조,고밀도지단백담고순(HDL-C)고우DM조;량조치료후BMI、HDL-C적변화치(△BMI、△HDL-C)차이유통계학의의.(3)기선시량조OGTT시험각점이도소수평、HOMA-IR급ISI무현저성차이,종점시NDM조OGTT시험0.5h、1h이도소수평급ISI고우DM조,HOMA-IR저우DM조;여DM조상비,NDM조치료후이도소적민감성명현개선.(4)Logistic회귀현시OGTT 0.5h이도소여DM적완해정독립정상관,△HOMA-IR、△BMI여DM적완해정독립부상관.결론 (1)장기종합간예가사상당다적T2DM환자획득완해.(2)공제체중、감경이도소저항、회복조상이도소분비시DM장기완해적중요인소.
Objective To investigate the effect of longterm integrated intervention on outcomes for glucose metabolism in patients with newly diagnosed type 2 diabetes mellitus(T2DM). Methods 129 cases with newly diagnosed T2DM received an integrated intervenetion for six years.The BMI,waisttohip ratio (WHR), blood pressure,lipids,fasting blood glucose(FBG)，2 hour postpradial glucose(2hPG)，HbA1c and fasting insulin(FIns) were determined.Insulin sensitivity index(ISI) and insulin resistance index(HOMA-IR) were calculated.At the end of followup,all patients took 75g OGTT. The patients were divided into DM group and nonDM group.The nonDM included normal glucose tolerance(NGT),impaired glucose tolerance (IGT),impaired fasting glucose(IFG) and IGT plus IFG. Results ①Six years later,14 cases (10.9%) of 129 T2DM subjects reverted to NGT,and 27 cases (20.9%) to IGT,IFG or IGT plus IFG,but 88 cases (68.2%) remained DM.②At baseline,the levels of FBG,WHR and triglyderides(TG) were significantly lower in nonDM group than in DM group.At the endpoint,WHR, HbA1c, FBG, 2hPG were significantly lower and HDL-C was higher in nonDM group than in DM group.After integrated intervention,the changes of BMI(△BMI) and HDL-C(△HDL-C) were significantly different between the two groups.③At the beginning,there was no significant difference between the two groups in ISI,HOMA-IR and the insulin levels at any time point during OGTT.Six years later,the insulin levels at 30min and 60min of the OGTT were higher in nonDM group than in DM group.Compared with DM group, nonDM group had higher level of ISI and lower level of HOMAIR at the endpoint.After six years of treatment， the changes of ISI(△ISI) and HOMA-IR(△HOMA-IR) were obviously higher in nonDM group than in DM group.④Logistic analysis showed that the insulin concentration at 30 min during OGTT was positively correlated with the remission of T2DM, and △ HOMAIR and △BMI after intervention were negatively correlated with the remission of T2DM. Conclusions The longterm integrated intervention can induce remission of DM in a great number of diabetic patients.Losing weight,improving insulin resistance and restoring the earlyphase of insulin secretion are important factors for the longterm remission of T2DM.