轻度空腹高血糖人群的非药物干预研究

Effects of nonpharmcological intervention on patients with mild fasting hyperglycemia

目的 观察轻度空腹高血糖人群饮食和/或运动的干预效果、及胰岛素抵抗对干预效果的影响。方法 选取初诊发现空腹血糖在6.1～7.8mmol/L之间的轻度空腹高血糖者129人,按不同干预方法随机分为单纯饮食组、饮食+运动组和对照组3组,在初访和随访1年后分别测量空腹血糖、空腹胰岛素,比较不同干预方法降低空腹血糖的作用,以及胰岛素抵抗的程度对干预效果的影响。结果 干预1年后,饮食+运动组平均空腹血糖低于单纯饮食组[(5.91±1.0)mmol/L,(6.9±1.5)mmot/L,P=0.000],平均胰岛素敏感性指数显著提高(-3.7±0.5,-4.0±0.6,P=0.011);单纯饮食组与对照组相比平均空腹血糖水平差异无显著性[(6.9±1.5)mmol/L,(7.1±1.0)mmol/L,P=0.454],但平均胰岛素敏感性指数显著升高(-4.0±0.6,-4.4±0.7,P=0.003)。以胰岛素敏感性指数值-4.2146为截点做分层分析,与干预前比较,胰岛素抵抗较轻干预组平均空腹血糖明显下降[(6.7±0.6)mmol/L,(6.2±1.0)mmol/L,P=0.001],胰岛素抵抗较重干预组血糖维持原有水平[(6.7±0.5)mmol/L,(6.6±1.6)mmol/L,P=0.505)。干预1年后的血糖变化与胰岛素敏感性改变、运动量的增加和每日摄入热量的改变存在线性相关(P<0.05)。结论 饮食、运动干预能改善高血糖人群胰岛素敏感性,使血糖、血压水平明显下?

Objective To assess the effects of nonpharmcological intervention with diet control and/or physical exercise on the patients with mild fasting hyperglycemia, and to evaluate the effect of insulin resistance on the intervention. Methods One hundred and twenty-nine patients with mild fasting hyperglycemia, defined as their fasting plasma glucose level of (6.1~7.8) mmol / L, and without diabetic history, were selected by screening. After baseline examination, all the 129 patients were divided randomly into three groups (control, diet intervention only and diet intervention plus physical exercise). The fasting blood glucose and fasting plasma insulin were reexamined after 12 months intervention.Results After intervention for 12 months, concentrations of fasting plasma glucose in the group with diet plus physical exercise intervention were significantly lower [(5.9±1.0) mmol/L] than those in the diet intervention only group (6.9±1.5) mmol/L, with P = 0.000, and insulin sensitive index (ISI, - 3.7±0.5) in the former was significantly higher than that in the latter ( - 4.0±0.6, P = 0.011). Although there was no significant difference in fasting plasma glucose level between the diet intervention only and control groups [(6.9±1.5) mmol/L vs (7.1±1.0)mmol/L,P =0.454], but ISI in the former was significantly higher than that in the latter ( - 4.0±0.6 vs - 4.4±0.7,P=0.003).Stratified by cutoff value of ISI - 4.214 6, average fasting plasma glucose level in those with milder insulin resistance was significantly lower after intervention than that before it [(6.7±0.6) mmol/L vs (6.2±1.0) mmol/L, P = 0.001], but, that in those with more severe insulin resistance kept their fasting plasma glucose unchanged after intervention [(6.7±0.5) mmol/L vs (6.6±1.6) mmol/L, P = 0.505] . Multiple linear regression analysis showed that there existed correlation between changes in fasting plasma glucose concentration, ISI, physical exercises and daily dietary intake (P < 0.05) .Conclusions Diet plus physical exercise intervention could improve their insulin sensitivity in those with mild fasting hyperglycemia and significantly decrease their levels of fasting plasma glucose and blood pressure. Insulin resistance could affect the effects of diet plus physical exercise intervention. Those with mild fasting hyperglycemia and more severe insulin resistance may need stronger nonpharmacological intervention and/or other therapy.