| 摘要: |
| 目的 通过对体检人群连续观察10年，了解在未经药物干预下空腹血糖受损（IFG）的糖尿病转化率及影响因素。方法 纳入2008-2018年连续11年在我院进行健康体检、年龄>18岁的3个功能社区人群557名。收集每次体检时受检者的空腹血糖、血压、总胆固醇和三酰甘油资料，分析2008年体检时确诊IFG患者与空腹血糖正常进展为IFG患者的糖尿病转化率。糖尿病定义为空腹血糖浓度≥ 7.0 mmol/L，或有糖尿病病史，或已使用胰岛素或口服降糖药进行治疗；IFG定义是无糖尿病病史、未接受降糖治疗，且空腹血糖浓度在5.6~6.9 mmol/L；空腹血糖正常定义为无糖尿病病史、未接受降糖治疗，且空腹血糖浓度<5.6 mmol/L。采用二分类logistic回归分析IFG向糖尿病转化的影响因素。结果 557例受检者中男283例，女274例，年龄为39（19~69）岁，2008年体检时确诊糖尿病患者25例（4.5%），IFG患者30例（5.4%），空腹血糖正常者502例。30例2008年体检时确诊IFG患者中14例（46.7%）10年内转化为糖尿病，11例（36.7%）5年内转化为糖尿病，其中5年内IFG转化为糖尿病组的脂肪肝（FL）患者比例和三酰甘油水平均高于未转化为糖尿病组（P均<0.05）。502例2008年体检时空腹血糖正常人群有177例在10年内进展为IFG，其中20例在之后随访中转化为糖尿病，转化为糖尿病组FL患者比例和三酰甘油水平均高于未转化为糖尿病组（P均<0.01）。二分类logistic回归分析显示，三酰甘油是首次诊断IFG向糖尿病转化和初始空腹血糖正常人群进展为IFG并进一步向糖尿病转化的独立危险因素（OR=2.43，95%CI 1.03~5.70，P<0.05；OR=1.50，95%CI 1.12~2.01，P<0.05）。结论 IFG是空腹血糖正常向糖尿病转化的一个重要阶段，三酰甘油是IFG向糖尿病转化的独立危险因素。 |
| 关键词: 空腹血糖受损 糖尿病前期 糖尿病 疾病恶化 三酰甘油 |
| DOI：10.16781/j.0258-879x.2020.12.1358 |
| 投稿时间：2020-06-11修订日期：2020-11-30 |
| 基金项目: |
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| Natural progression from impaired fasting glucose to diabetes mellitus and its influencing factors |
| FAN Jian-ling*,ZHANG Ying-qiu,XIAO Yi |
(Health Management Center, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the rate and the influencing factors of progression from impaired fasting glucose (IFG) to diabetes mellitus without drug intervention by continuous observation for 10 years in physical examination population. Methods A total of 557 people aged over 18 years who had physical examination in our hospital from 2008 to 2018 were included. The data of fasting blood glucose, blood pressure, total cholesterol and triglyceride were collected at every physical examination. The progression rate to diabetes mellitus in IFG patients diagnosed in 2008 and patients with normal fasting blood glucose progression to IFG were analyzed. Diabetes mellitus was defined as fasting blood glucose ≥ 7.0 mmol/L, or with a history of diabetes mellitus, or having been treated with insulin or oral hypoglycemic drugs; IFG was defined as no history of diabetes mellitus, receiving no hypoglycemic therapy, and fasting blood glucose being 5.6-6.9 mmol/L; normal fasting blood glucose was defined as no history of diabetes mellitus, receiving no hypoglycemic therapy, and fasting blood glucose <5.6 mmol/L. Binary logistic regression was used to analyze the influencing factors of progression from IFG to diabetes mellitus. Results There were 283 males and 274 females, aged 39 (19-69) years. Twenty-five cases (4.5%) were diagnosed with diabetes mellitus, 30 cases (5.4%) with IFG, and 502 cases with normal fasting blood glucose in 2008. In the 30 IFG cases, 14 (46.7%) cases progressed to diabetes mellitus within 10 years and 11 (36.7%) cases within 5 years. The proportion of patients with fatty liver (FL) and the level of triglyceride in the progressed group were higher than those in the non-progressed group within 5 years (both P<0.05). Among the 502 cases with normal fasting glucose in 2008, 177 cases progressed to IFG within 10 years, and 20 cases progressed to diabetes mellitus during the subsequent follow-up. The proportion of FL patients and triglyceride level in the progressed group were significantly higher than those in the nonprogressed group (both P<0.01). Binary logistic regression analysis showed that triglyceride was an independent risk factor for people with first diagnosis of IFG and then progressed to diabetes mellitus and those with normal initial fasting blood glucose and then progressed to IFG and further to diabetes mellitus (OR=2.43, 95% CI 1.03-5.70, P<0.05; OR=1.50, 95% CI 1.12-2.01, P<0.05). Conclusion IFG is an important stage of progression from normal fasting blood glucose to diabetes mellitus, and triglyceride is an independent risk factor for IFG to diabetes mellitus. |
| Key words: impaired fasting glucose prediabetic state diabetes mellitus disease progression triglycerides |
