1 Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
2 Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Int J Stroke. 2018 Dec;13(9):941-948. doi: 10.1177/1747493018784432. Epub 2018 Jun 29.
We sought to determine the effect of regression to normal glucose tolerance (NGT) or progression to diabetes in early years of impaired glucose tolerance (IGT) on subsequent risk of stroke.
In 1986, 576 adults aged 25 years and older with impaired glucose tolerance in Da Qing, China, were randomly assigned by clinic to control, diet, exercise, or diet plus exercise intervention groups for a six-year period. Subsequently participants received medical care in their local clinics. We tracked participants for additional 17 years to ascertain stroke events and other outcomes.
At the end of 6-year intervention trial follow-up, 272 (50.2%) had progressed to diabetes, 169 (31.2%) regressed to normal glucose tolerance, and 101 (18.6%) remained impaired glucose tolerance. During the subsequent 17-year follow-up, 173 (31.9%) developed a stroke, 26.7% of normal glucose tolerances, 30.7% of impaired glucose tolerances, and 36.1% of those with diabetes. After controlling for age, sex, baseline blood pressure, smoking, total cholesterol, previous cardiovascular disease and intervention group, those who developed diabetes in the first six years had a higher incidence of stroke than those who reverted to normal glucose tolerance (HR = 1.49, 95% CI 1.01-2.19, p = 0.04), whereas for those who remained impaired glucose tolerance compared to those who regressed to normal glucose tolerance the HR was 1.25 (95% CI 0.80-1.93; p = 0.30). A 1-mmol/L increase in both fasting and 2-h post-load plasma glucose from entry to end of the six-year trial was significantly associated with a higher risk of development of stroke in the subsequent 17 years, respectively (HR = 1.07, 95% CI 1.03-1.11, p < 0.0001 for fasting glucose, HR = 1.05, 95% CI 1.02-1.09, p = 0.007 for 2-h post-load plasma glucose).
Among Chinese adults with impaired glucose tolerance, early progression to diabetes predicted a higher risk of stroke, compared those who regressed to normal glucose tolerance.
我们旨在探讨早期糖耐量受损（IGT）时血糖恢复正常或进展为糖尿病对随后中风风险的影响。
1986 年，中国大庆 576 名年龄在 25 岁及以上的成年人被随机分配到对照组、饮食组、运动组或饮食加运动组，进行为期 6 年的干预试验。随后，参与者在当地诊所接受医疗护理。我们对参与者进行了 17 年的跟踪随访，以确定中风事件和其他结果。
在 6 年干预试验随访结束时，272 名（50.2%）进展为糖尿病，169 名（31.2%）恢复正常糖耐量，101 名（18.6%）仍为糖耐量受损。在随后的 17 年随访中，173 名（31.9%）发生中风，正常糖耐量者中风发生率为 26.7%，糖耐量受损者为 30.7%，糖尿病者为 36.1%。在控制年龄、性别、基线血压、吸烟、总胆固醇、既往心血管疾病和干预组后，前 6 年发生糖尿病的患者中风发生率高于恢复正常糖耐量的患者（HR=1.49，95%CI 1.01-2.19，p=0.04），而与恢复正常糖耐量的患者相比，糖耐量仍受损的患者的 HR 为 1.25（95%CI 0.80-1.93；p=0.30）。从入组到 6 年试验结束时，空腹和 2 小时餐后血浆葡萄糖分别增加 1mmol/L，与随后 17 年中风发生风险显著相关（空腹血糖 HR=1.07，95%CI 1.03-1.11，p<0.0001；2 小时餐后血浆葡萄糖 HR=1.05，95%CI 1.02-1.09，p=0.007）。
在中国糖耐量受损的成年人中，与恢复正常糖耐量者相比，早期进展为糖尿病预测中风风险更高。
