糖调节受损者的临床干预研究

Clinical Intervention in Patients with IGR

目的评价对糖调节受损(IGR)患者药物及非药物干预作用。方法将IGR患者263例随机分为5组:①饮食及运动干预组(51例);②二甲双胍组(53例),二甲双胍0.25g,3次/d;③吡格列酮组(52例),吡格列酮15mg,1次/d;④诺和龙组(51例):诺和龙0.25mg,3次/d;⑤对照组(56例)。空腹及餐后血糖、空腹胰岛素、糖化血红蛋白、血脂、血压、肝肾功能与干预前后分别监测。结果糖调节受损者糖尿病年发生率:药物干预组与对照组和饮食运动组比较显著降低,差异有显著性(P<0.05);药物及饮食运动组空腹及餐后血糖降低;空腹胰岛素降低;HOMA-IR降低;胰岛素敏感性改善;甘油三酯降低,SOD升高,收缩压、舒张压降低,与对照组相比,差异有显著性(P<0.05);发生糖尿病的危险度饮食及运动组降低37.3%,二甲双胍组降低75.3%,吡格列酮组降低74.6%,诺和龙组降低84.9%.结论药物干预可延缓和预防糖尿病及心血管疾病的发生和发展,优于非药物干预。

Objective To evaluate the influence of drug intervention and non-drug intervention in patients with impaired glucose regulation （IGR）. Methods This study involved 263 patients with IGR and without renal/hepatic insufficiency in outpatients and patients in health check-up group. They were randomly divided into five groups ： ①diet and exercise intervention group ; ②flumamine intervention group ： flumamine 0.25 tid; ③pioglitazone intervention group ： pioglitazone 15 mg qd ; ④repaglinide intervention group ： repaglinide 0.25 mg tid; ⑤controlled group. They were all measured FPG,2hPG, FINS, HbA1c,TC, TG, hepatic function and renal function before and after 12 months intervention. Results The incidence rate per year of diabetes ： drug intervention groups are lower than non-drug intervention, groups （ P 〈 0. 05 ）. The clinical items of chemical examinations of the intervention groups are lower than controlled group（ P 〈0. 05 ）. The decline of hazard rate of DM contrasting to the controlled group：37.3% in diet and exercise intervention group,75.3 % in flumamine intervention group,74.6% in pioglitazone intervention group,84.9% in repaglinide group. Conclusion Clinical intervention in patients with IGRcan delay or prevent the occurrences of type 2 diabetes mellitus （DM） and cardiovascular complications. And drug intervention is more effective than non-drug intervention.