每日步数对糖耐量异常社区居民糖代谢转归的影响

Impact of daily step count on glycemic outcomes of community residents with impaired glucose tolerance

目的探讨每日步数对糖耐量异常(IGT)社区居民糖代谢转归的影响。方法本研究为前瞻性队列研究,于2018年10月在北京市石景山区招募符合IGT诊断标准的204例常住居民,检测其空腹血糖、口服葡萄糖耐量试验2 h血糖(2 h BG)、糖化血红蛋白(HbA 1c)、血脂、肝肾功能,测量其身高、体重、腰围等指标。通过专用应用程序每月推送糖尿病前期健康宣教知识,并在线指导解答疑问,应用程序收集每日步数数据。3年后复查受试者糖代谢情况及其他指标,共有142例受试者完成随访纳入研究。根据每日步数>7000步、5000~7000步和<5000步将受试者分为高步数组(42例)、中步数组(54例)和低步数组(46例),根据糖代谢转归情况分为糖尿病组(30例)、糖尿病前期组(77例)和正常血糖组(35例)。采用独立样本t检验比较两组间血糖、血脂、步数等资料差异,采用Kruskal-Wallis H检验或单因素方差分析比较多组间血糖、血脂、步数等资料差异,采用χ^(²)检验比较多组间糖代谢转归等资料差异,采用多元logistic回归分析每日步数、体重指数等对糖代谢转归的影响,采用线性回归分析评估每日步数与2 h BG之间的关系。结果纳入分析的142例受试者中,男性43例,女性99例,年龄(60.15±5.67)岁,基线时男性体重指数、腰围、空腹血糖水平均显著高于女性[(26.97±2.43)比(24.89±2.93)kg/m^(2)、(92.68±7.75)比(83.83±8.60)cm、(5.83±0.61)比(5.62±0.52)mmol/L],总胆固醇、HDL-C水平均显著低于女性[(5.10±1.16)比(5.55±0.95)mmol/L、(1.35±0.34)比(1.56±0.35)mmol/L](均P<0.05)。经过3年的跟踪随访,21.1%(30/142)的IGT受试者进展为糖尿病,年转化率约为7%。正常血糖组每日步数显著高于糖尿病前期组和糖尿病组[(7886±2867)比(5981±2655)、(4117±2674)步](H=31.778,P<0.001)。高步数组体重指数、2 h BG、HbA 1c水平均显著低于中步数组和低步数组[(24.26±3.09)比(25.44±3.38)、(26.26±3.59)kg/m^(2),(7.50±1.71)比(9.15±3.30)、(11.19±3.84)mmol/L,5.97%±0.46%比6.14%±0.99%、6.40%±0.96%](均P<0.05)。高步数与糖尿病前期逆转为正常血糖呈正相关(中步数,OR=0.297,95%CI:0.109~0.804;低步数,OR=0.055,95%CI:0.010~0.287),低步数与糖尿病前期进展为糖尿病呈正相关(OR=4.857,95%CI:1.140~20.689)(均P<0.05)。每日步数每增加1000步,2 h BG降低0.5 mmol/L(P<0.001)。结论随着每日步数增加,IGT社区居民糖代谢状况改善,较高的每日步数与IGT逆转为正常血糖相关,较低的每日步数与IGT进展为糖尿病相关。

ObjectiveTo investigate the impact of daily step count on glycemic outcomes in community residents with impaired glucose tolerance(IGT).MethodsThis was a prospective cohort study,in October 2018,204 residents who met the criteria of IGT were recruited in the Shijingshan District in Beijing.The subjects were tested for fasting blood glucose,oral glucose tolerance test 2-hour blood glucose(2hBG),glycated hemoglobin A 1c(HbA 1c),lipid profile,liver and kidney function,as well as measurements of height,weight and waist circumference.A dedicated mobile application was used to deliver prediabetes health knowledge monthly.Online guidance was provided to answer questions and daily step count was collected using the application.Three years later,a follow-up was conducted to assess the participants′glycemic outcomes and other indexes,and a total of 142 participants completed the follow-up review.According to daily step count,the subjects were categorized into high step count group(42 cases,>7000 steps daily),moderate step count group(54 cases,5000-7000 steps daily),and low step count group(46 cases,<5000 steps daily).Subjects were categorized into diabetes group(30 cases),prediabetes group(77 cases)and normal glucose tolerance group(35 cases)with glycemic outcomes.Independent sample t test was used to compare the differences in blood glucose,blood lipids,and step counts between the two groups.Kruskal-Wallis H test or one-way ANOVA was used to compare the differences in blood glucose,blood lipids,and step counts between multiple groups.The χ^(2)test was used to compare the differences in glycemic outcomes between multiple groups.Multivariate logistic regression analysis was used to assess the impact of daily step counts and body mass index on glycemic outcomes.Linear regression analysis was used to evaluate the relationship between daily step counts and 2 h BG.ResultsA total of 142 participants completed the 3-year follow-up,including 43 males and 99 females,with a mean age of(60.15±5.67)years.At baseline,males had significantly higher body mass index,waist circumference,and fasting blood glucose when compared to those in females[(26.97±2.43)vs(24.89±2.93)kg/m^(2),(92.68±7.75)vs(83.83±8.60)cm,(5.83±0.61)vs(5.62±0.52)mmol/L],the total cholesterol and HDL-C were also significantly lower in males than those in females[(5.10±1.16)vs(5.55±0.95)mmol/L,(1.35±0.34)vs(1.56±0.35)mmol/L](all P<0.05).After 3-year follow-up,21.1%(30/142)of IGT participants progressed to diabetes,with an annual conversion rate of approximately 7%.The normal glucose tolerance group showed significantly higher daily step counts when compared with the prediabetes and diabetes groups[(7886±2867)vs(5981±2655)vs(4117±2674)steps](H=31.778,P<0.001).Individuals with higher daily step counts exhibited lower body mass index,2 h BG,and HbA 1c level when compared with those in the ones with moderate and low step counts[(24.26±3.09)vs(25.44±3.38)vs(26.26±3.59)kg/m 2,(7.50±1.71)vs(9.15±3.30)vs(11.19±3.84)mmol/L,5.97%±0.46%vs 6.14%±0.99%vs 6.40%±0.96%](all P<0.05).Higher step count was positively correlated with the reversal of prediabetes to normal blood glucose levels(moderate step count,OR=0.297,95%CI:0.109-0.804;low step count,OR=0.055,95%CI:0.010-0.287),lower daily step count correlated positively with prediabetes progressing to diabetes(OR=4.857,95%CI:1.140-20.689)(all P<0.05).For every additional 1000 steps per day,the 2 h BG decreased by 0.5 mmol/L.ConclusionAs daily step count increases,the glucose metabolism improves in IGT community residents.Higher daily step count is associated with reversal of IGT to normal glucose tolerance,while lower daily step count may be associated with the progression of IGT to diabetes.