糖调节受损者的生活方式干预及血浆Visfatin与ADMA水平的关系研究
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摘要
目的
调查风雨坛社区居民糖调节受损(IGR)和糖尿病(DM)的患病情况和知晓率；对社区IGR人群开展生活方式干预治疗,探索适合社区开展、易于为中老年居民接受和坚持的糖尿病防治管理方法；研究不同程度的糖代谢异常者心血管疾病和内皮功能不全的相关指标——非对称性二甲基精氨酸(ADMA)及血浆Visfatin水平的变化,分析血浆Visfatin与ADMA的关系,并探讨糖代谢紊乱状态下Visfatin水平变化的意义。
方法
1、以2192名社区中老年常住人口为研究对象,采用横断面研究的调查方法,测量身高、体重、血压、腰围、臀围,检测空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG),问卷调查IGR、DM和高血压病的知晓率,其中FBG≥5.6mmol/L者,当日行75g口服葡萄糖耐量试验(OGTT)。
2、已筛查的IGR人群1-2周内检测空腹胰岛素(FINS)、糖化血红蛋白(HbA1c),同步检测FBG,计算体重指数(BMI)、腰臀比(BMR)、胰岛素抵抗指数(HOMA-IR)、胰岛p细胞功能指数(HOMA-β)。随后对干预组IGR人群开展社区为中心的生活方式干预治疗,1年后对干预组和对照组进行随访,复查OGTT、FINS、HbA1c、TC和TG。
3、应用酶联免疫吸附法检测26例正常糖耐量(NGT)、32例IGR、30例DM者的血浆Visfatin与ADMA水平,计算血浆致动脉粥样硬化指数(AIP),同时检测FBG、葡萄糖负荷后2小时血糖(2hBG)、FINS、葡萄糖负荷后2小时胰岛素(2hINS)、TC、TG、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),测量身高、体重、血压、腰围、臀围,分析各变量间的关系。
结果
1、本社区中老年居民IGR、DM患病率分别为11.04%和18.80%,糖耐量异常(IGT)、空腹血糖异常(IFG)患病率分别为8.76%和2.28%,80岁以前,IGR和DM患病率均随年龄增加而增加,70-79岁组达到高峰,患病率分别为13.70%和21.68%,80岁以后IGR和DM患病率均下降,各年龄组IGR患病率均高于同年龄组新诊断糖尿病的患病率。
2、不同性别组IGR、IFG、IGT、DM患病率差异无统计学意义(P>0.05)。
3、社区中老年居民超重／肥胖、血脂异常症的患病率均超过50%。IGT、IGR及DM的患病率均随着体重指数的增加而增加,在肥胖组患病率达到高峰,分别为12.20%、14.24%、26.78%；IGT患病率高于相同体重指数组IFG的患病率。伴高甘油三酯血症组IFG、IGT、IGR、DM患病率明显高于血清甘油三酯正常组,相同脂代谢状态人群中,DM患病率明显高于同组IGR患病率,IGT患病率明显高于同组IFG患病率。
4、DM、高血压病知晓率分别为54.85%、67.86%,IGR知晓率仅2.48%,超过50%的居民本次调查前未曾检测血糖。
5、对IGR人群开展生活方式干预治疗,1年后219例(干预组157例,对照组62例)研究对象完成随访。干预组逆转为NGT的比例高于对照组,分别为50.32%和33.87%,差异有统计学意义(P<0.05),干预组进展为DM的比例低于对照组,分别为5.73%和16.13%,差异有统计学意义(P<0.05)。
6、干预1年后,干预组体重、臀围、收缩压(SBP)、舒张压(DBP)、FBG、2hBG、HbA1c低于对照组(P<0.01, P<0.05), FINS、HOMA-β高于对照组(P<0.05)；1年后干预组体重、臀围、体重指数(BMI)、SBP、DBP、FBG、2hBG、HbA1c、TG低于基线水平(P<0.01),腰臀比(WHR)、FINS、HOMA-β高于基线水平(P<0.01,P<0.05)。
7、Pearson相关分析发现,△FBG(FBG基线-FBG干预后)与△体重(体重基线-体重干预后)、△臀围(臀围基线-臀围干预后)、△DBP(DBP基线-DBP干预后)和△HOMA-β(HOMA-β干预后-HOMA-β基线)呈正相关(P<0.01,P<0.05),△2hBG(2hBG基线-2hBG干预后)与△体重、ADBP呈正相关(P<0.01,P<0.05),△HbA1c(HBA1c基线-HBA1c干预后)与△体重、△SBP(SBP基线-SBP干预后)、△DBP、△FINS(FINS干预后-FINS基线)、△HOMA-β呈正相关(P<0.01)。Spearman等级相关分析发现,△FBG与△主食量(每日主食减少量)、△烹调油(每月烹调油减少量)呈正相关(P<0.05),A2hBG与△主食量、△烹调油、△运动量(每日体力活动增加量)呈正相关(P<0.01,P<0.05),△HbA1c与△烹调油呈正相关(P<0.05)。
8、干预组心绞痛发作人次低于对照组(P<0.05),且发作与增加体力活动未发现直接关系。
9、从NGT、IGR到DM组,血浆Visfatin、ADMA水平逐步增加,DM组血浆Visfatin水平高于NGT组(P<0.01),但IGR组与DM组及NGT组比较,Visfatin水平差异均无统计学意义(P>0.05)。IGR、DM组ADMA水平均高于NGT组,DM组ADMA水平高于IGR组,三组间ADMA水平差异均有统计学意义(P<0.01)。
10、Pearson相关分析表明,血浆Visfatin水平与体重、腰围、BMI、WHR、FBG、2hBG、HbA1c、TG、AIP、FINS、HOMA-IR、ADMA呈正相关(P<0.01,P<0.05),与HDL-C、HOMA-β呈负相关(P<0.01),与年龄、臀围、SBP、DBP、TC、LDL-C、2hINS无显著相关性(P>0.05)。
11、多元线性逐步回归分析表明ADN△A和AIP是影响血浆Visfatin水平最显著的因素。
结论
1、近10年来中老年人群IGR、DM患病率明显升高。社区中老年人群健康状况不容乐观,社区居民IGR的知晓率极低,错过了DM发生前糖代谢异常的可逆阶段,因此在高危人群中开展IGR的筛查并给予干预治疗十分必要。
2、以社区为单位开展生活方式干预可改善中老年IGR人群的糖脂代谢紊乱和胰岛β细胞功能,同时减少心血管事件的发生。在糖代谢异常逆转为NGT的过程中,胰岛p细胞功能改善可能先于胰岛素抵抗的改善。IGR人群糖代谢紊乱的改善伴随体重、血压、血脂的改善和胰岛p细胞功能的改善,并且糖代谢紊乱的改善程度与生活方式的改善程度呈正相关。
3、Visfatin与糖代谢关系密切,可能是T2DM发生发展过程中对胰岛p细胞功能下降、胰岛素分泌相对不足、血糖升高的一种代偿机制。Visfatin与内皮功能不全和动脉粥样硬化、心血管疾病密切相关,可能对内皮功能具有保护作用,推测血浆Visfatin水平的增加是慢性糖代谢紊乱加重过程中内皮功能不全的一个保护性代偿机制,血浆Visfatin可作为内皮功能的一个标志物。
Objective
To investigate the prevalence and awareness rate of impaired glucose regulation (IGR) and diabetes mellitus (DM) in Fengyutan community. To carry out lifestyle interventions to explore the management model for preventing DM which is adapt to communities and acceptable to the middle-aged and older people. To study the changes of plasma visfatin and asymmetric dimethylarginine (ADMA) levels in the subjects with different glucose tolerances, as well as analyze the relationship between plasma visfatin and ADMA.
Methods
1. A cross-sectional study was performed in 2192 middle-aged and elder subjects in the Fengyutan community. The participants were examined standing height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference and hip circumference and measured fasting blood glucose (FBG), total cholesterol (TC) and triglyeride (TG). Questionnaires of awareness rate of IGR, DM and hypertension were also investigated The subjects with FBG levels of 5.6mmol/L or greater were performed 75g oral glucose tolerance test (OGTT).
2. The IGR subjects were measured fasting serum insulin (FINS),hemoglobin Alc (HbAlc) within a week or two, and body mass index (BMI) and waist to hip ratio (WHR), homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment-isletβ-cell function (HOMA-β) were also calculated. The intervention group was performed lifestyle interventions in the community. After one year, the intervention group and the control group were followed-up to re-examine OGTT, FINS, HbA1c, TC and TG.
3. Fasting plasma visfatin and ADMA levels were measured by enzyme-linked immunosorbent assay in 26 subjects of normal glucose tolerance (NGT),32 subjects of IGR and 30 subjects of DM. Meanwhile FBG,2h Blood Glucose after glucose load (2hBG), FINS,2h Insulin after glucose load (2hINS), TC, TG, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured, and standing height, body weight, SBP, DBP, waist circumference and hip circumference were examined. The atherogenic index of plasma (AIP), BMI, WHR, HOMA-IR and HOMA-P were also calculated. Furthermore we analyzed the correlation between the plasma visfatin level and other indexes.
Results
1. The prevalences were 11.04%for IGR,18.80%for DM,8.76%for impaired glucose tolerance (IGT) and 2.28%for impaired fasting glucose (IFG) in the FengYuTan community. The prevalences of IGR and DM increased with age before the age of 80 years and the maximum prevalences of IGR and DM were 13.70%and 21.68%in 70-to79-year age group, respectively. The prevalence of IGR was higher than that of new diabetes mellitus in every age group.
2. The prevalences of IGR, IFG, IGT and DM had no significant difference between male and female populations(P>0.05).
3. The prevalences of overweight, obesity and dyslipidemia were above to 50%, respectively. The prevalences of IGT, IGR and DM increased with BMI, and the maximum prevalences of those were 12.20%,14.24%and 26.78%in the obesity group, respectively. The prevalence of IGT was higher than that of IFG in every BMI group. The prevalences of IFG, IGT, IGR and DM in hypertriglyceridemia groups were higher than those in normal triglyceridemia groups. The prevalence of DM was higher than that of IGR, and the prevalence of IGR than that of IFG in every blood lipid group.
4. The awareness rates of DM and hypertension were 54.85%and 67.86%, respectively. While the awareness rates of IGR was merely 2.48%. More than 50% participants had never measured blood glucose.
5. We carried out lifestyle interventions in the IGR subjects for one year and 219 subjects (157 of the intervention group and 52 of the control group) were followed-up. After intervention, there were 50.32%IGT in the intervention group and 33.87%IGT in the control group who reverted to NGT(P<0.05), meanwhile 5.73%and 16.13%who progressed to DM, respectively (P<0.05).
6. After intervention, body weight, hip circumference; SBP, DBP, FBG,2hBG and HbA1c of the intervention group were all decreased compared with those of the control group (P＜0.01, P＜0.05), and FINS and HOMA-βof the intervention group were higher than those of the control group (P＜0.05). Body weight, hip circumference, BMI, SBP, DBP, FBG,2hBG, HbA1c and TG of the intervention group were all decreased compared with those at baseline (P＜0.01), and WHR, FINS and HOMA-βwere higher than those at baseline (P＜0.01, P＜0.05).
7. Pearson correlation analysis showed that the decrement of FBG (AFBG) had a significant positive correlation with the decrement of body weight (AWt), the decrement of hip circumference (AHc), the decrement of DBP (ADBP) and the increment of HOMA-p (AHOMA-β)(P＜0.01, P＜0.05), and the decrement of 2hBG (A2hBG) with AWt and ADBP(P<0.01, P＜0.05), and the decrement of HbA1c(AHbA1c) with AWt and the decrement of SBP(ASBP), ADBP, the increment of FINS (AFINS) and AHOMA-β(P＜0.01). Spearman rank correlation analysis showed that AFBG had a significant positive correlation with the decrement of food per day (AFood) and the decrement of cooking-oil per month (AOil)(P＜0.05), and A2hBG with AFood, AOil and the increment of physical activity per day (AActivity)(P＜0.01, P＜0.05), and AHbA1c with AOil (P＜0.05).
8. The incidence of angina attack in the intervention group was less than that in the control group(P<0.05) and we found no direct relationship between the angina attack and the physical activity.
9. From the NGT, IGR to DM group, plasma visfatin and ADMA levels increased gradually. The plasma visfatin levels in the DM group were significantly higher than those in the NGT group (P＜0.01), whereas no differences were found between the IGR group and the DM group or the NGT group (P>0.05). The ADMA levels increased in the IGR group and the DM group significantly compared with the NGT group, and those in the DM group increased compared with those in the IGR group (P＜0.01).
10. Pearson correlation analysis showed that the level of visfatin was positively correlated with body weight, waist circumference, BMI, WHR, FBG,2hBG, HbAlc, TG, AIP, FINS, HOMA-IR and ADMA (P＜0.01,P＜0.05), and negatively correlated with HDL-C and HOMA-β(P＜.01), but did not correlate with age, hip circumference, SBP, DBP, TC, LDL-C and 2hINS (P>0.05).
11. Multiple linear stepwise regression analysis showed that the levels of ADMA and AIP were the strongest influential factors on the plasma levels of visfatin.
Conclusions
1. The prevalences of IGR and DM in middle-aged and elder population have increased remarkablely in the last decade. Their health status is far from satisfaction. The community inhabitants have missed the chance that abnormal glucose tolerance may revert to normal glucose tolerance. Accordingly, it is essential that IGR screening programmes should be implementd and that intervention means be performed in the high-risk groups.
2. The community-based lifestyle intervention can improve the glycemia and lipidic metabolic disturbance and pancreatic isletβ-cell function impairment, while reducing the incidence of cardiovascular events. The improvement of pancreatic isletβ-cell function may precede to that of insulin resistance in the process of abnormal glucose regulation reversal to NGT. The improvement of glycemia dysregulation accompanies with the improvement of body weitht, blood pressure, blood lipid and pancreatic islet P-cell function, and is positively correlated with lifestyle improvement.
3. Visfatin is closely related with glycemia metabolism, and may one of the compensatory mechanisms to the impairment of pancreatic isletβ-cell function and the relative lack of insulin secretion in the progress of type 2 diabetes mellitus. Visfatin is also closely related with endothelial dysfunction, atherosclerosis and cardiovascular diseases, suggesting that increased levels of plasma visfatin could play a protective role to the endothelial function. Elevated blood levels of visfatin maybe one of the protective compensatory mechanisms to the endothelial function in the aggravating glycemia metabolism process. The plasma visfatin levels may act as a marker of endothelial function.
调查风雨坛社区居民糖调节受损(IGR)和糖尿病(DM)的患病情况和知晓率；对社区IGR人群开展生活方式干预治疗,探索适合社区开展、易于为中老年居民接受和坚持的糖尿病防治管理方法；研究不同程度的糖代谢异常者心血管疾病和内皮功能不全的相关指标——非对称性二甲基精氨酸(ADMA)及血浆Visfatin水平的变化,分析血浆Visfatin与ADMA的关系,并探讨糖代谢紊乱状态下Visfatin水平变化的意义。
方法
1、以2192名社区中老年常住人口为研究对象,采用横断面研究的调查方法,测量身高、体重、血压、腰围、臀围,检测空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG),问卷调查IGR、DM和高血压病的知晓率,其中FBG≥5.6mmol/L者,当日行75g口服葡萄糖耐量试验(OGTT)。
2、已筛查的IGR人群1-2周内检测空腹胰岛素(FINS)、糖化血红蛋白(HbA1c),同步检测FBG,计算体重指数(BMI)、腰臀比(BMR)、胰岛素抵抗指数(HOMA-IR)、胰岛p细胞功能指数(HOMA-β)。随后对干预组IGR人群开展社区为中心的生活方式干预治疗,1年后对干预组和对照组进行随访,复查OGTT、FINS、HbA1c、TC和TG。
3、应用酶联免疫吸附法检测26例正常糖耐量(NGT)、32例IGR、30例DM者的血浆Visfatin与ADMA水平,计算血浆致动脉粥样硬化指数(AIP),同时检测FBG、葡萄糖负荷后2小时血糖(2hBG)、FINS、葡萄糖负荷后2小时胰岛素(2hINS)、TC、TG、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),测量身高、体重、血压、腰围、臀围,分析各变量间的关系。
结果
1、本社区中老年居民IGR、DM患病率分别为11.04%和18.80%,糖耐量异常(IGT)、空腹血糖异常(IFG)患病率分别为8.76%和2.28%,80岁以前,IGR和DM患病率均随年龄增加而增加,70-79岁组达到高峰,患病率分别为13.70%和21.68%,80岁以后IGR和DM患病率均下降,各年龄组IGR患病率均高于同年龄组新诊断糖尿病的患病率。
2、不同性别组IGR、IFG、IGT、DM患病率差异无统计学意义(P>0.05)。
3、社区中老年居民超重／肥胖、血脂异常症的患病率均超过50%。IGT、IGR及DM的患病率均随着体重指数的增加而增加,在肥胖组患病率达到高峰,分别为12.20%、14.24%、26.78%；IGT患病率高于相同体重指数组IFG的患病率。伴高甘油三酯血症组IFG、IGT、IGR、DM患病率明显高于血清甘油三酯正常组,相同脂代谢状态人群中,DM患病率明显高于同组IGR患病率,IGT患病率明显高于同组IFG患病率。
4、DM、高血压病知晓率分别为54.85%、67.86%,IGR知晓率仅2.48%,超过50%的居民本次调查前未曾检测血糖。
5、对IGR人群开展生活方式干预治疗,1年后219例(干预组157例,对照组62例)研究对象完成随访。干预组逆转为NGT的比例高于对照组,分别为50.32%和33.87%,差异有统计学意义(P<0.05),干预组进展为DM的比例低于对照组,分别为5.73%和16.13%,差异有统计学意义(P<0.05)。
6、干预1年后,干预组体重、臀围、收缩压(SBP)、舒张压(DBP)、FBG、2hBG、HbA1c低于对照组(P<0.01, P<0.05), FINS、HOMA-β高于对照组(P<0.05)；1年后干预组体重、臀围、体重指数(BMI)、SBP、DBP、FBG、2hBG、HbA1c、TG低于基线水平(P<0.01),腰臀比(WHR)、FINS、HOMA-β高于基线水平(P<0.01,P<0.05)。
7、Pearson相关分析发现,△FBG(FBG基线-FBG干预后)与△体重(体重基线-体重干预后)、△臀围(臀围基线-臀围干预后)、△DBP(DBP基线-DBP干预后)和△HOMA-β(HOMA-β干预后-HOMA-β基线)呈正相关(P<0.01,P<0.05),△2hBG(2hBG基线-2hBG干预后)与△体重、ADBP呈正相关(P<0.01,P<0.05),△HbA1c(HBA1c基线-HBA1c干预后)与△体重、△SBP(SBP基线-SBP干预后)、△DBP、△FINS(FINS干预后-FINS基线)、△HOMA-β呈正相关(P<0.01)。Spearman等级相关分析发现,△FBG与△主食量(每日主食减少量)、△烹调油(每月烹调油减少量)呈正相关(P<0.05),A2hBG与△主食量、△烹调油、△运动量(每日体力活动增加量)呈正相关(P<0.01,P<0.05),△HbA1c与△烹调油呈正相关(P<0.05)。
8、干预组心绞痛发作人次低于对照组(P<0.05),且发作与增加体力活动未发现直接关系。
9、从NGT、IGR到DM组,血浆Visfatin、ADMA水平逐步增加,DM组血浆Visfatin水平高于NGT组(P<0.01),但IGR组与DM组及NGT组比较,Visfatin水平差异均无统计学意义(P>0.05)。IGR、DM组ADMA水平均高于NGT组,DM组ADMA水平高于IGR组,三组间ADMA水平差异均有统计学意义(P<0.01)。
10、Pearson相关分析表明,血浆Visfatin水平与体重、腰围、BMI、WHR、FBG、2hBG、HbA1c、TG、AIP、FINS、HOMA-IR、ADMA呈正相关(P<0.01,P<0.05),与HDL-C、HOMA-β呈负相关(P<0.01),与年龄、臀围、SBP、DBP、TC、LDL-C、2hINS无显著相关性(P>0.05)。
11、多元线性逐步回归分析表明ADN△A和AIP是影响血浆Visfatin水平最显著的因素。
结论
1、近10年来中老年人群IGR、DM患病率明显升高。社区中老年人群健康状况不容乐观,社区居民IGR的知晓率极低,错过了DM发生前糖代谢异常的可逆阶段,因此在高危人群中开展IGR的筛查并给予干预治疗十分必要。
2、以社区为单位开展生活方式干预可改善中老年IGR人群的糖脂代谢紊乱和胰岛β细胞功能,同时减少心血管事件的发生。在糖代谢异常逆转为NGT的过程中,胰岛p细胞功能改善可能先于胰岛素抵抗的改善。IGR人群糖代谢紊乱的改善伴随体重、血压、血脂的改善和胰岛p细胞功能的改善,并且糖代谢紊乱的改善程度与生活方式的改善程度呈正相关。
3、Visfatin与糖代谢关系密切,可能是T2DM发生发展过程中对胰岛p细胞功能下降、胰岛素分泌相对不足、血糖升高的一种代偿机制。Visfatin与内皮功能不全和动脉粥样硬化、心血管疾病密切相关,可能对内皮功能具有保护作用,推测血浆Visfatin水平的增加是慢性糖代谢紊乱加重过程中内皮功能不全的一个保护性代偿机制,血浆Visfatin可作为内皮功能的一个标志物。
Objective
To investigate the prevalence and awareness rate of impaired glucose regulation (IGR) and diabetes mellitus (DM) in Fengyutan community. To carry out lifestyle interventions to explore the management model for preventing DM which is adapt to communities and acceptable to the middle-aged and older people. To study the changes of plasma visfatin and asymmetric dimethylarginine (ADMA) levels in the subjects with different glucose tolerances, as well as analyze the relationship between plasma visfatin and ADMA.
Methods
1. A cross-sectional study was performed in 2192 middle-aged and elder subjects in the Fengyutan community. The participants were examined standing height, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference and hip circumference and measured fasting blood glucose (FBG), total cholesterol (TC) and triglyeride (TG). Questionnaires of awareness rate of IGR, DM and hypertension were also investigated The subjects with FBG levels of 5.6mmol/L or greater were performed 75g oral glucose tolerance test (OGTT).
2. The IGR subjects were measured fasting serum insulin (FINS),hemoglobin Alc (HbAlc) within a week or two, and body mass index (BMI) and waist to hip ratio (WHR), homeostasis model assessment-insulin resistance (HOMA-IR) and homeostasis model assessment-isletβ-cell function (HOMA-β) were also calculated. The intervention group was performed lifestyle interventions in the community. After one year, the intervention group and the control group were followed-up to re-examine OGTT, FINS, HbA1c, TC and TG.
3. Fasting plasma visfatin and ADMA levels were measured by enzyme-linked immunosorbent assay in 26 subjects of normal glucose tolerance (NGT),32 subjects of IGR and 30 subjects of DM. Meanwhile FBG,2h Blood Glucose after glucose load (2hBG), FINS,2h Insulin after glucose load (2hINS), TC, TG, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured, and standing height, body weight, SBP, DBP, waist circumference and hip circumference were examined. The atherogenic index of plasma (AIP), BMI, WHR, HOMA-IR and HOMA-P were also calculated. Furthermore we analyzed the correlation between the plasma visfatin level and other indexes.
Results
1. The prevalences were 11.04%for IGR,18.80%for DM,8.76%for impaired glucose tolerance (IGT) and 2.28%for impaired fasting glucose (IFG) in the FengYuTan community. The prevalences of IGR and DM increased with age before the age of 80 years and the maximum prevalences of IGR and DM were 13.70%and 21.68%in 70-to79-year age group, respectively. The prevalence of IGR was higher than that of new diabetes mellitus in every age group.
2. The prevalences of IGR, IFG, IGT and DM had no significant difference between male and female populations(P>0.05).
3. The prevalences of overweight, obesity and dyslipidemia were above to 50%, respectively. The prevalences of IGT, IGR and DM increased with BMI, and the maximum prevalences of those were 12.20%,14.24%and 26.78%in the obesity group, respectively. The prevalence of IGT was higher than that of IFG in every BMI group. The prevalences of IFG, IGT, IGR and DM in hypertriglyceridemia groups were higher than those in normal triglyceridemia groups. The prevalence of DM was higher than that of IGR, and the prevalence of IGR than that of IFG in every blood lipid group.
4. The awareness rates of DM and hypertension were 54.85%and 67.86%, respectively. While the awareness rates of IGR was merely 2.48%. More than 50% participants had never measured blood glucose.
5. We carried out lifestyle interventions in the IGR subjects for one year and 219 subjects (157 of the intervention group and 52 of the control group) were followed-up. After intervention, there were 50.32%IGT in the intervention group and 33.87%IGT in the control group who reverted to NGT(P<0.05), meanwhile 5.73%and 16.13%who progressed to DM, respectively (P<0.05).
6. After intervention, body weight, hip circumference; SBP, DBP, FBG,2hBG and HbA1c of the intervention group were all decreased compared with those of the control group (P＜0.01, P＜0.05), and FINS and HOMA-βof the intervention group were higher than those of the control group (P＜0.05). Body weight, hip circumference, BMI, SBP, DBP, FBG,2hBG, HbA1c and TG of the intervention group were all decreased compared with those at baseline (P＜0.01), and WHR, FINS and HOMA-βwere higher than those at baseline (P＜0.01, P＜0.05).
7. Pearson correlation analysis showed that the decrement of FBG (AFBG) had a significant positive correlation with the decrement of body weight (AWt), the decrement of hip circumference (AHc), the decrement of DBP (ADBP) and the increment of HOMA-p (AHOMA-β)(P＜0.01, P＜0.05), and the decrement of 2hBG (A2hBG) with AWt and ADBP(P<0.01, P＜0.05), and the decrement of HbA1c(AHbA1c) with AWt and the decrement of SBP(ASBP), ADBP, the increment of FINS (AFINS) and AHOMA-β(P＜0.01). Spearman rank correlation analysis showed that AFBG had a significant positive correlation with the decrement of food per day (AFood) and the decrement of cooking-oil per month (AOil)(P＜0.05), and A2hBG with AFood, AOil and the increment of physical activity per day (AActivity)(P＜0.01, P＜0.05), and AHbA1c with AOil (P＜0.05).
8. The incidence of angina attack in the intervention group was less than that in the control group(P<0.05) and we found no direct relationship between the angina attack and the physical activity.
9. From the NGT, IGR to DM group, plasma visfatin and ADMA levels increased gradually. The plasma visfatin levels in the DM group were significantly higher than those in the NGT group (P＜0.01), whereas no differences were found between the IGR group and the DM group or the NGT group (P>0.05). The ADMA levels increased in the IGR group and the DM group significantly compared with the NGT group, and those in the DM group increased compared with those in the IGR group (P＜0.01).
10. Pearson correlation analysis showed that the level of visfatin was positively correlated with body weight, waist circumference, BMI, WHR, FBG,2hBG, HbAlc, TG, AIP, FINS, HOMA-IR and ADMA (P＜0.01,P＜0.05), and negatively correlated with HDL-C and HOMA-β(P＜.01), but did not correlate with age, hip circumference, SBP, DBP, TC, LDL-C and 2hINS (P>0.05).
11. Multiple linear stepwise regression analysis showed that the levels of ADMA and AIP were the strongest influential factors on the plasma levels of visfatin.
Conclusions
1. The prevalences of IGR and DM in middle-aged and elder population have increased remarkablely in the last decade. Their health status is far from satisfaction. The community inhabitants have missed the chance that abnormal glucose tolerance may revert to normal glucose tolerance. Accordingly, it is essential that IGR screening programmes should be implementd and that intervention means be performed in the high-risk groups.
2. The community-based lifestyle intervention can improve the glycemia and lipidic metabolic disturbance and pancreatic isletβ-cell function impairment, while reducing the incidence of cardiovascular events. The improvement of pancreatic isletβ-cell function may precede to that of insulin resistance in the process of abnormal glucose regulation reversal to NGT. The improvement of glycemia dysregulation accompanies with the improvement of body weitht, blood pressure, blood lipid and pancreatic islet P-cell function, and is positively correlated with lifestyle improvement.
3. Visfatin is closely related with glycemia metabolism, and may one of the compensatory mechanisms to the impairment of pancreatic isletβ-cell function and the relative lack of insulin secretion in the progress of type 2 diabetes mellitus. Visfatin is also closely related with endothelial dysfunction, atherosclerosis and cardiovascular diseases, suggesting that increased levels of plasma visfatin could play a protective role to the endothelial function. Elevated blood levels of visfatin maybe one of the protective compensatory mechanisms to the endothelial function in the aggravating glycemia metabolism process. The plasma visfatin levels may act as a marker of endothelial function.
引文
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3 Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care.1997; 20: 1664-1669.
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7 Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with life style intervention or metformin. N Engl J Med.2002; 346:393-403.
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2 International Diabetes Federation. Diabetes Atlas. Third Edition.2006; http://www. eatlas.idf.org/Prevalence/.
3 Jia WP, Pang C, Chen L, et al. Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population:the Shanghai diabetes studies, a cross-sectional 3-year follow-up study in Shanghai urban communities. Diabetologia.2007; 50: 286-292.
4 Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care.199.7; 20: 1664-1669.
5 Piche ME, Lemieux S, Perusse L, et al. High normal 2-hour plasma glucose is associated with insulin sensitivity and secretion that may predispose to type 2 diabetes. Diabetologia. 2005; 48:732-740.
6 Gautier JF, Wilson C, Weyer C, et al. Low acute insulin secretory responses in adult offspring of people with early onset type 2 diabetes. Diabetse.2001; 50:1828-1833.
7 Perseghin G, Ghosh S, Gerow K, et al. Metabolic defects in lean nondiabetic offspring of NIDDM parents:a cross-sectional study. Diabetes.1997; 46:1001-1009.
8 World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO Consultation. Part 1:Diagnosis and Classification of Diabetes Mellitus. Geneva, World Health Org.1999.
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10 Genuth S, Alberti KG, Bennett P, et al. The Expert Committee on the diagnosis and classification of diabetes mellitus:Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care.2003; 26:3160-3167.
11 Muhammad A, Abdul-Ghani, Devhit Y, et al. Contributions of (3-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose. Diabetes Care.2006; 29:1130-1139.
12 The DECODE Study Group. Age-and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care.2003; 26:61-69.
13 Valdes S, Botas P, Delgado E, et al. Population-based incidence of type 2 diabetes in northern Spain:the Asturias Study. Diabetes Care.2007; 30:2258-2263.
14 Bonora E, Kiechl S, Willeit J, et al. Population-based incidence rats and risk factors for type 2 diabetse in white individuals:the Bruneck Study. Diabetes.2004; 53:1782-1789.
15 Shaw JE. Zimmet PZ. de Courten M. et al. Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius? Diabetes Care.1999:22:399-402.
16 Lyssenko V, Almgren P, Anevski D, et al. Botnia Study Group:Predictors of and longitudinal changes in insulin sensitivity and secretion preceding onset of type 2 diabetes. Diabetes.2005; 54:166-174.
17 DeVegt F. Dekker J, Jager A, et al. Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population:the Hoorn Study. JAMA.2001; 285: 2109-2113.
18 Tominaga M. Eguchi H, Manaka H, et al Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care.1999; 22:920-924.
19 Qiao Q. Hu G, Tuomilehto J. et al. Age-and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diabetes Care.2003; 26:1770-1780.
20 The DECODE Study Group. Gender difference in all-cause and cardiovascular mortality related to hyperglacemia and newly-diagnosed diabetes. Diabetologia.2003; 46:608-617.
21 The DECODE Study Group. Consequences of the new diagnostic criteria for diabetes in older men and women. DECODE Study (Diabetes Epidemiology:Collaborative Analysis of Diagnostic Criteria in Europe). Diabetes Care.1999; 22:1667-1671.
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24 International Diabetes Federation. Diabetes Atlas, Third Edition.2006; http://www.eatlas.idf.org/Costs of diabetes/
25 Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care.1997; 20:537-544.
26 Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in life style among subjects with impaired glucose tolerance. N Engl J Med.2001; 344: 1343-1350.
27 Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with life style intervention or metformin. N Engl J Med.2002; 346:393-403.
28 Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2 diabetes mellitus:the STOP-NIDDM randomised trial. Lancet.2002; 359:2072-2077.
29杨文英,林丽香,齐今吾,等.阿卡波糖和二甲双胍对IGT人群糖尿病预防的效果——多中心3年前瞻性观察.中华内分泌代谢杂志.2001；17：131-134.
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32 Li GW, Zhang P, Wang JP, et al. The long-term effects of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study:a 20-year follow-up study. Lancet. 2008; 371:1783-1789.
33 Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention:follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006; 368:1673-1679.
34 The Diabetes Prevention Program Research Group. Effects of withdrawal from metformin on the development of diabetes in the Diabetes Prevention Program. Diabetes Care.2003; 26: 977-980.
2 Jia WP, Pang C, Chen L, et al. Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population:the Shanghai diabetes studies, a cross-sectional 3-year follow-up study in Shanghai urban communities. Diabetologia.2007; 50: 286-292.
3 Pan XR, Yang WY, Li GW, et al. Prevalence of diabetes and its risk factors in China,1994. National Diabetes Prevention and Control Cooperative Group. Diabetes Care.1997; 20: 1664-1669.
4 http//www.eatlas.idf.org/media.
5 Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care.1997; 20:537-544.
6 Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in life style among subjects with impaired glucose tolerance. N Engl J Med.2001; 344: 1343-1350.
7 Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with life style intervention or metformin. N Engl J Med.2002; 346:393-403.
8 Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2 diabetes mellitus the STOP-NIDDM randomised trial. Lancet.2002; 359:2072-2077.
9杨泽.中国中老年人糖尿病和糖耐量异常的流行病学研究.中华流行病学杂志.2003；24：410-412.
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