Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Puolijoki H, Tuomilehto J, Vanhala M, Moilanen L, Uusitupa M, Keinänen-Kiukaanniemi S
Institute of Health Sciences, University of Oulu, Oulu, Finland.
Unit of General Practice, Oulu University Hospital, Oulu, Finland.
Diabet Med. 2015 Dec;32(12):1611-6. doi: 10.1111/dme.12776. Epub 2015 May 8.
To examine changes in glucose metabolism (fasting and 2-h glucose) during follow-up in people with impaired fasting glucose in comparison with changes in people with isolated impaired glucose tolerance, people with impaired fasting glucose and impaired glucose tolerance combined and people with screening-detected Type 2 diabetes at baseline, among those who participated in a diabetes prevention programme conducted in Finland.
A total of 10 149 people at high risk of Type 2 diabetes took part in baseline examination. Of 5351 individuals with follow-up ≥ 9 months, 1727 had impaired glucose metabolism at baseline and completed at least one lifestyle intervention visit. Most of them (94.6%) were overweight/ obese.
Fasting glucose decreased during follow-up among overweight/obese people in the combined impaired fasting glucose and impaired glucose tolerance group (P = 0.044), as did 2-h glucose in people in the isolated impaired glucose tolerance group (P = 0.0014) after adjustment for age, sex, medication and weight at baseline, follow-up time and changes in weight, physical activity and diet. When comparing changes in glucose metabolism among people with different degrees of glucose metabolism impairment, fasting glucose concentration was found to have increased in those with isolated impaired glucose tolerance (0.12 mmol/l, 95% Cl 0.05 to 0.19) and it decreased to a greater extent in those with screening-detected Type 2 diabetes (-0.54 mmol/l, 95% Cl -0.69 to -0.39) compared with those with impaired fasting glucose (-0.21 mmol/l, 95% Cl -0.27 to -0.15). Furthermore, 2-h glucose concentration decreased in the isolated impaired glucose tolerance group (-0.82 mmol/l, 95% Cl -1.04 to -0.60), in the combined impaired fasting glucose and impaired glucose tolerance group (-0.82 mmol/l, 95% Cl -1.07 to -0.58) and in the screening-detected Type 2 diabetes group (-1.52, 95% Cl -1.96 to -1.08) compared with those in the impaired fasting glucose group (0.26 mmol/l, 95% Cl 0.10 to 0.43). Results were statistically significant even after adjustment for covariates (P < 0.001 in all models).
Changes in glucose metabolism differ in people with impaired fasting glucose from those in people with isolated impaired glucose tolerance, people with impaired fasting glucose and impaired glucose tolerance combined and people with screening-detected Type 2 diabetes.
在参与芬兰一项糖尿病预防项目的人群中，比较空腹血糖受损者在随访期间葡萄糖代谢（空腹血糖和餐后2小时血糖）的变化，与单纯糖耐量受损者、空腹血糖受损合并糖耐量受损者以及基线时筛查发现的2型糖尿病患者的变化情况。
共有10149名2型糖尿病高危人群参加了基线检查。在5351名随访时间≥9个月的个体中，1727人在基线时存在葡萄糖代谢受损，并完成了至少一次生活方式干预访视。其中大多数人（94.6%）超重/肥胖。
在调整年龄、性别、用药情况、基线体重、随访时间以及体重、体力活动和饮食变化后，空腹血糖受损合并糖耐量受损组的超重/肥胖人群在随访期间空腹血糖下降（P = 0.044），单纯糖耐量受损组人群的餐后2小时血糖下降（P = 0.0014）。在比较不同程度葡萄糖代谢受损人群的葡萄糖代谢变化时，发现单纯糖耐量受损者的空腹血糖浓度升高（0.12 mmol/l，95%可信区间0.05至0.19），与空腹血糖受损者（-0.21 mmol/l，95%可信区间-0.27至-0.15）相比，筛查发现的2型糖尿病患者空腹血糖下降幅度更大（-0.54 mmol/l，95%可信区间-0.69至-0.39）。此外，与空腹血糖受损组（0.26 mmol/l，95%可信区间0.10至0.43）相比，单纯糖耐量受损组（-0.82 mmol/l，95%可信区间-1.04至-0.60）、空腹血糖受损合并糖耐量受损组（-0.82 mmol/l，95%可信区间-1.07至-0.58）以及筛查发现的2型糖尿病组（-1.52，95%可信区间-1.96至-1.08）的餐后2小时血糖浓度均下降。即使在调整协变量后，结果仍具有统计学意义（所有模型中P < 0.001）。
空腹血糖受损者的葡萄糖代谢变化与单纯糖耐量受损者、空腹血糖受损合并糖耐量受损者以及筛查发现的2型糖尿病患者不同。
