生活方式干预对糖耐量低减患者早期胰岛素分泌障碍的影响

Effects of life style intervention on early insulin secretion in the patients with impaired glucose tolerance

目的探讨生活方式干预对糖耐量低减(impairedglucosetolerance,IGT)患者早期胰岛β细胞分泌障碍的影响,并观察对糖化血红蛋白(glycosylatedhemoglobinA1c,HbA1c)、体质量指数(bodymassindex,BMI)的改善作用。方法采用随机的方法将商丘市第一人民医院就诊的符合世界卫生组织1999年关于糖尿病的诊断和分类标准,3个月内经2次OGTT检查确诊为IGT患者46例IGT患者分为两组,对照组(n=23)单纯进行健康宣教,实验组(n=23)在健康宣教的基础上,采用饮食控制及运动疗法进行生活方式干预,观察6个月。分析对比两组治疗前后静脉葡萄糖耐量试验(intravenousglucosetolerancetest,IVGTT)所诱发的胰岛素第一时相分泌、胰岛素曲线下面积、及由Homa模型计算的HomaB,HomaA指数,同时观察口服葡萄糖耐量试验2h血糖、人体质量指数、HbA1c。结果干预后实验组胰岛β细胞功能显著改善,IVGTT各时点胰岛素分泌及HomaB值明显升高[IVGTT1,2,3,10min空腹胰岛素水平分别为(9.87±1.79),(10.10±1.82),(9.95±1.75)和(9.77±1.71)mg/L];有5例患者复恢了典型的胰岛素一相分泌峰值,HomaA指数显著下降,BMI及HbA1c分别较干预前下降了1.9kg/m2和0.6%;与干预前比较,差异有显著性意义(t=-1.02～0.79,P均<0.05)。对照组以上各项指标无显著性改变。

AIM:To explore the influence of life style intervention on the early secretory disorder of pancreas islets beta(β) cell function,and to observe its effect in improving glycosylated hemoglobin A1c(HbA1c) and body mass index(BMI) in patients with impaired glucose tolerance(IGT).METHODS:A total of 46 patients,who were diagnosed to have IGT by oral glucose tolerance test(OGTT) for twice within 3 months and in accordance with the diagnostic and classification criteria of diabetes raised by WHO in 1999,were selected from the First People's Hospital of Shangqiu City.All the patients were randomly divided into two groups:control group(n=23) and study group(n=23).All the patients received conventional education on diabetes prevention,and besides,patients in the study group underwent life style interventions of an individually designed diet and exercise program.After 6 months,the insulin secretion in first phase,the mean area under the curve of insulin,Homa B and Homa A indexes induced by intravenous glucose tolerance test(IVGTT) were assessed and compared between the two groups before and after study.The 2 hour postprandial glucose levels by OGTT,HbA1c and BMI were also observed.RESULTS:Six months after life style intervention in the study group,the β cell function was significantly improved at different time point,the first phase insulin secreted by IVGTT and Homa B were apparently increased[the fasting insulin levels at 1,2,3 and 10 minutes of IVGTT were(9.87±1.79),(10.10±1.82),(9.95±1.75) and(9.77±1.71) mg/L].Five patients restored to the peak of fist phase insulin secretion,the Homa A index was significantly decreased,the BMI and HbA1c were reduced by 1.9 kg/m2 and 0.6%respectively as compared with those before intervention(t=-1.02 to 0.79,P< 0.05).While no significant changes of the indexes mentioned were observed in the control group,and there were significant differences between the two groups(t=0.12-2.23,P< 0.05).CONCLUSION:Life style intervention can effectively not only decrease the insulin resistance but also improve the insulin secretory disorder at the early stage in the patients with IGT,and the natural history of the patients with IGT can be converse to different degrees.