上海市泗泾地区>40岁非糖尿病人群3年转归及相关因素分析

Analysis of 3-year prognosis and related factors of non-diabetic population aged over 40 years in Sijing area of Shanghai

目的探讨>40岁非糖尿病人群3年进展为糖尿病的发生率及其影响因素,为糖尿病的筛查及早期防治提供科学依据。方法采用队列研究,以2013年上海市泗泾地区体检中非糖尿病居民为观察对象,将其分为正常糖耐量(NGT)组和糖调节受损(IGT)组,观察其糖代谢异常的自然转归,以是否转归为糖尿病为因变量,年龄、BMI和生化指标为自变量,进行相关分析与logistic回归分析。结果共随访5 212人3年,非糖尿病人群2型糖尿病(T2DM)累积发病率为10.86%,NGT组为5.26%,IGR组为19.83%;3年累积发病率比较:空腹血糖受损(IFG)组、IGT组和IFG+IGT组均高于NGT组,IFG+IGT组高于IFG组和IGT组,差异均有统计学意义(P值均<0.05)。年龄、糖代谢异常、高胆固醇、肥胖、高血压对糖尿病发生、进展均有影响,其中糖代谢异常是最重要的危险因素;胰岛素抵抗人群相关回归分析表明,空腹胰岛素、空腹血糖、BMI水平与胰岛素抵抗指数及分泌指数最为相关。结论泗泾地区>40岁人群3年糖尿病累积发病率为10.86%,糖尿病发病风险与年龄、糖代谢异常、高胆固醇、肥胖、高血压水平显著相关;与胰岛素抵抗与分泌关系最相关的因素是空腹胰岛素、空腹血糖、肥胖及甘油三酯水平。应控制血糖、血脂的水平,提高胰岛素敏感性,延缓胰岛素抵抗的发生。

Objective To study the incidence of diabetes mellitus and its influencing factors among non-diabetic population over 40 years old in Shanghai Sijing area within 3 years;to provide scientific basis for screening and early prevention and treatment of diabetes mellitus.Methods Using cohort study,the residents of non-diabetes mellitus among residents aged over 40 years in Sijing area were recruited as queue objects in 2013.The subjects were divided into normal glucose tolerance(NGT)group and impaired glucose regulation(IGR)group,whose natural outcomes of abnormal glucose metabolism were observed.Using whether to turn to diabetes as a dependent variable and age,BMI together with biochemical indexes as independent variables,correlation analysis and regression analysis were conducted.Results A total of 5 212 residents were subjected to followup studies for 3 years,the cumulative incidence of type 2 diabetes mellitus(T2 DM)in non-diabetic population was 10.86%.The cumulative incidence of T2 DM in NGT and IGR group was 5.26%and 19.83%,respectively.Compared with the 3-year cumulative incidence of T2 DM among different groups:IFG group,IGT group and IFG+IGT group had higher incidences than that in NGT group(all P<0.05);the T2 DM prevalence of IFG+IGT group was higher than that of IFG and IGT group,all above differences were statistically significant(all P<0.05).Age,abnormal glucose metabolism,hypercholesterolemia,obesity and hypertension all had effects on the occurrence and progress of diabetes,among which abnormal glucose metabolism was the most important risk factor;regression analysis for insulin resistance population showed that the levels of fasting insulin,fasting blood sugar and BMI were most likely related to insulin resistance index and secretion index.Conclusion The3-year cumulative incidence of diabetes in the population over 40 years old is 10.86%in Sijing area.The risk of diabetes is significantly correlated with age,abnormal glucose metabolism,high cholesterol,obesity and hypertension.The most relevant factors related to insulin resistance and secretion are fasting insulin,fasting blood glucose,obesity and triglyceride levels.The blood glucose and lipid levels should be controlled to improve insulin sensitivity and delay the occurence of insulin resistance.