糖尿病预防研究的创举:大庆糖尿病预防研究36年回顾

Innovation in diabetes prevention research:The 36-year legacy of China Da Qing diabetes prevention study

糖尿病前期是血糖介于正常范围和糖尿病诊断标准之间的一类高血糖状态,该人群每年有5%~10%的风险会进展为糖尿病,终身患糖尿病的风险达70%.糖尿病是全球五大慢性病之一,每年造成近万亿美元的卫生支出.我国糖尿病患者数量和因糖尿病死亡数量均位居全球首位,且未来30年数量仍将增长,预防糖尿病刻不容缓.大庆糖尿病预防研究是世界上开始时间最早、干预时间和随访时间最长的通过改变生活方式预防糖尿病的随机对照研究,与美国糖尿病预防项目、芬兰糖尿病预防研究共同被誉为糖尿病一级预防领域的里程碑式研究,自1986年至今已有36年历史,首次提供通过改变生活方式可以预防糖尿病的强有力证据,并进一步证明生活方式干预在干预结束后能持续降低30年糖尿病发病风险和相关并发症(如视网膜病变、心血管疾病)及其死亡的发生风险,甚至延长1.44年的寿命,为糖尿病防控工作提供了科学证据.随着人口老龄化进程加快和人均预期寿命提高,糖尿病相关疾病负担日渐加重,学习和借鉴大庆糖尿病预防研究为应对当前糖尿病挑战具有重要意义.为此,本文对大庆糖尿病预防研究的时代背景、研究设计、主要成果和贡献做系统介绍与回顾,并对未来的糖尿病预防研究方向进行思考与展望.

Prediabetes,also known as impaired glucose regulation(IGR),is an intermediate stage between normal glycemia and diabetes.It includes people with elevated,but sub-diabetic fasting glucose levels,called impaired fasting glucose(IFG),and postprandial glucose intolerance,called impaired glucose tolerance(IGT).In some diagnostic criteria,individuals with HbA1c 5.7%–6.4%are regarded as prediabetes as well.Around 5%–10%of individuals with prediabetes become diabetic annually,and up to 70%progress to diabetes within their lifetime.As one of the top five chronic diseases in healthcare globally,diabetes incurs an average medical expenditure of nearly one trillion dollars per year.China is the country with the highest number of diabetes cases and diabetes-related death worldwide,urgent action is needed to address diabetes in China.The China Da Qing Diabetes Prevention Study(CDQDPS),a randomized controlled trial started in 1986,demonstrated the efficacy of lifestyle intervention to prevent type 2 diabetes mellitus(T2DM).Along with the US Diabetes Prevention Program(DPP)and the Finnish Diabetes Prevention Study(DPS),the CDQDPS has been regarded as the landmark study for primary prevention of T2DM by lifestyle intervention,but with the longest duration of intervention and follow-up since 1986.Due to long-term follow-up of up to 30 years,the CDQDPS remains the only trial to date that reported the efficacy of lifestyle intervention to reduce the risk of cardiovascular disease(CVD)and death caused by T2DM among individuals with IGT.The global epidemic of T2DM has prompted numerous studies and public health efforts to reduce its development.A crucial challenge is associated with the ununified diagnostic criteria of prediabetes by various international professional organizations,for instance,the American Diabetes Association(ADA)defines IFG as a fasting plasma glucose(FPG)level above 100 mg/dL(5.6 mmol/L),whereas the World Health Organization(WHO)sets the threshold at 110 mg/dL(6.1 mmol/L).Furthermore,the diagnosis of prediabetes based on different measurements:FPG,2-hour plasma glucose,and HbA1c has different insulin sensitivity,β-cell function,and risk of developing T2DM and incident CVD events.Therefore,it’s important to investigate whether there is a difference in the efficacy of lifestyle intervention to prevent T2DM among individuals with prediabetes defined by different diagnostic criteria,such as isolated IFG(i-IFG),and elevated HbA1c.Additionally,with the advent of the internet as a resource base for research and the need to bridge the know-do gap,further research is required to provide robust evidence on the effectiveness of digital intervention on lifestyle management in preventing T2DM,and it’s necessary to identify barriers and facilitators to implement lifestyle intervention and evaluate the acceptability,adoption,appropriateness,implementation costs,feasibility,fidelity,penetration,and sustainability of interventions.All in all,this review summarizes the background,study design,main results,and contributions of the CDQDPS,and help inform future studies in diabetes prevention and public health efforts to address the epidemic of T2DM.