糖尿病和心血管病预防的破冰之旅——大庆糖尿病预防研究30年

Breakthrough in diabetes and cardiovascular disease prevention:a 30-year study of diabetes prevention in Daqing

2型糖尿病已成为世界范围内一个巨大的和不断增长的公共健康问题,它极大地增加了失明、肾功能衰竭、心肌梗死和脑卒中发病的风险.20世纪80年代无人知晓糖尿病是否可以预防,直到2000年糖尿病学界仍不能确定生活方式干预是否可以延迟糖尿病的发生,也未能证实预防糖尿病能否延缓糖尿病血管并发症,从而减少死亡.大庆糖尿病预防研究是第一个来回答这些问题的研究.这个研究结果表明,新诊断糖尿病23年累积死亡率为56%,比血糖正常者提前10年,其中50%是死于心血管疾病.逾90%的糖耐量受损者在随后的20年随访中会发展成为糖尿病,其中33%的人死亡,44%的人至少发生了一次心脑血管事件.死亡和心血管事件主要发生于随访中进展为糖尿病的人群中.小组为单位的6年的生活方式干预对糖尿病预防有长达数以十年计的后效应.生活方式干预明显减少糖尿病的严重视网膜病变、心血管疾病及全因死亡风险.该研究已经、正在并将继续对世界糖尿病及其血管并发症预防产生重要的影响.

Type 2 diabetes represents an immense and growing public health challenge worldwide for its extremely high risk of blindness, renal failure, myocardial infarction and stroke. In the 1980 s, it was unclear whether diabetes is preventable. Up to 2000, it remained unclear whether diabetes can be delayed over a long period by active lifestyle intervention and whether the benefits of diabetes prevention can extend to the prevention of diabetic vascular complications and the reduction of mortality. The Diabetes Prevention Study in Daqing is one of the first studies to answer these questions. The major lessons we learnt from this study are as follows. Over 23 years, 56%people with newly diagnosed diabetes died, of whom 50% died of cardiovascular disease（CVD） with a 10-year less life expectancy.More than 90% people with impaired glucose tolerance（IGT） experienced diabetes, 33% of whom died and 44% had at least one CVD event in the subsequent 20 years. The all-cause death and CVD events over 20 years＇ follow-up period in this IGT population mainly occurred after the progression to diabetes. A group-based lifestyle interventions over 6-year period had long-term effects on prevention of diabetes beyond the period of 6-year active intervention. Benefits of the intervention significantly reduced severe diabetes retinopathy and extended to a favorable reduction of CVD and all-cause mortality. This study has an important impact on the worldwide prevention of diabetes and its vascular complications.