体重指数与初诊2型糖尿病代谢状态及慢性并发症的关系

Associations of body mass index with metabolic status and chronic complications in newly-diagnosed type 2 diabetic patients

目的探讨肥胖程度与糖尿病患者代谢状态及慢性并发症的关系。方法将新诊断的2型糖尿病患者以体重指数分为3组,分别比较空腹血糖及餐后血糖、血压、血脂、胰岛素抵抗指数、空腹C肽水平及大血管/微血管并发症患病率。结果低体重患者主要临床特征为胰岛素分泌水平低下,HbA_lc及空腹血糖增高。超重、肥胖的糖尿病患者主要表现为高血压、胰岛素抵抗、高甘油三酯和低高密度脂蛋白胆固醇血症。超重组易伴发高血压及冠心病等大血管病变,而低体重组微血管病变尤其是视网膜病变较为突出。结论对于初诊的低体重患者,应尽早补充胰岛素并及时筛查视网膜病变等微血管并发症;对于超重患者应强调减肥、降压、调脂等综合治疗。

Objective To investigate the association of body mass index （BMI） with metabolic status and chronic complications in newly-diagnosed Chinese type 2 diabetic patients. Methods A total of 515 newlydiagnosed adults type 2 diabetic patients were categorized into underweight （ BMI 〈 18. 5 kg/m^2 ）, normal weight （ BMI 18. 5-22. 9 kg/m^2 ） and overweight （ BMI t〉 23. 0 kg/m^2 ） groups. Metabolic parameters and prevalence of micro/macro vascular complications were compared among 3 groups. Results Clinical feature of lean diabetics were impaired insulin secretion, more severe hyperglycemia （significantly increased HbA1C and fasting plasma glucose） and favorable lipid profile compared to other groups and were prone for microvascular complications, whereas over-weight diabetics showed significant insulin resistant and were prone for macrovascular complications such as hypertension, coronary heart disease. Conclusion Facing a newly diagnosed diabetics, clinicians should put emphasis on screening for micrevascular complications and initiating insulin therapy earlier in underweight type 2 diabetics ; while for the obese, more attention should be paid to multifactorial interventions like reducing weight, decreasing blood pressure and improving dyslipidemia and insulin resistance.