上海黄浦区社区糖调节异常居民生活方式干预效果评价

Life style interventions study on the effects of impaired glucose regulations in Shanghai urban communities

目的评价生活方式干预对中国城市社区糖调节异常人群的效果。方法随机整群抽取上海黄浦区2个社区,将社区232名>35岁糖调节异常居民随机分配至运动干预组(58人)、膳食干预组(57人)、综合干预(运动+膳食)组(59人)和对照组(58人),接受6个月的干预。在研究开始和结束时对所有研究对象进行体格检查和生化指标检测(包括空腹血糖、OGTT、HbA1c、总胆固醇等)。结果与对照组相比,无论是运动干预、膳食干预还是两者结合的综合干预,社区IGR居民的空腹血糖、OGTT、HbA1c、总胆固醇、BMI、WHR和血压均明显降低(P<0.05);运动干预组和综合干预组血脂的降低亦有统计学差异(P<0.05);高密度脂蛋白只有综合干预组观察到了有统计学意义的增加(P<0.05);而不同干预组之间低密度脂蛋白的改变均未发现统计学差异。对照组的糖尿病6个月累积发病率为8.6%,而各干预组中均未发现糖尿病,差别有统计学意义(Fisher精确P=0.002);对照组6个月累积的血糖转为正常率为3.4%,低于各干预组(分别为8.6%,14.0%和16.9%),但是只有综合干预组的差别有统计学意义(OR=5.74,95%CI1.19～27.64,P=0.029)。结论短期生活方式干预可以改善上海市社区糖调节异常居民的代谢相关指标,降低糖尿病的发病风险和促进向正常血糖转化,特别是综合干预措施效果明显。

Objective To access the effects of life style interventions on impaired glucose regulation（IGR） in Shanghai urban communities,China.Method Two communities were randomly cluster-sampled to be carried out epidemiological intervention trial.Totally,232 subjects with IGR were randomly allocated into 4 groups：control group,sports intervention group,diet intervention group,and sports and diet intervention group with the physical examinations in the baseline and end of this study respectively.Tests for fasting blood glucose,OGTT,HbA1c,total cholesterol,etc.were done.Data statistical analysis was occupied in SPSS 16.0.Results Compared to subjects of control group,fasting blood glucose,OGTT,HbA1c,total cholesterol,BMI,waist hip ratio and blood pressures were significantly decreased among subjects with three interventions（P0.05）.Triglyceride were significantly decreased among subjects with sports intervention and sports and diet intervention（P0.05）.High density lipids was significantly increased among subjects with sports and diet intervention（P0.05）.There was a significant difference in 6 months cumulative incidence of diabetes mellitus between control group and interventions groups（8.6% vs.0,Fisher＇s exact P=0.002）,and the rate of transferring into normal blood glucose levels（fasting blood glucose 5.6 mmol/L and 2 hours OGTT 7.8 mmol/L） in control group was lower than those in three interventions group（3.4% vs.8.6%,14.0% and 16.9%,respectivley） but only significant difference was observed between control group and sports and diet intervention group（OR=5.74,95%CI 1.19-27.64,P=0.029）.Conclusion The life style interventions could decrease the risk of diabetes mellitus,help their transferring into normal blood glucose,and improve diabetic measures for the IGR population in Shanghai urban communities.