Center of Endocrinology and Cardiovascular Metabolism, Fuwai Hospital, Beijing, China.
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Diabetologia. 2021 Jun;64(6):1279-1287. doi: 10.1007/s00125-021-05401-x. Epub 2021 Feb 19.
AIMS/HYPOTHESIS: We aimed to determine associations of regression to normal glucose tolerance (NGT), maintaining impaired glucose tolerance (IGT) or progression to diabetes with subsequent risks of CVD and microvascular disease among Chinese adults with IGT.
We conducted an observational study among 540 participants in the Da Qing Diabetes Prevention Study, a 6 year lifestyle intervention trial in people with IGT, defined by 1985 WHO criteria as fasting plasma glucose <7.8 mmol/l and 2 h post-load plasma glucose ≥7.8 and <11.1 mmol/l. At the end of the trial, the groups that had regressed to NGT, remained with IGT or progressed to diabetes were identified. Participants were then followed for 24 years after completion of the trial, during which we compared the incidence and hazard ratios for CVD and microvascular disease in each group and estimated the differences in their median time to onset from parametric Weibull distribution models.
At the end of the 6 year trial, 252 (46.7%) participants had developed diabetes, 114 (21.1%) had remained with IGT and 174 (32.2%) had regressed to NGT. Compared with those who developed diabetes during the trial, the median time to onset of diabetes was delayed by 14.86 years (95% CI 12.49, 17.25) in the NGT and 9.87 years (95% CI 8.12, 11.68) in the IGT groups. After completion of the trial, among those with diabetes, IGT and NGT, the 24 year cumulative incidence of CVD was 64.5%, 48.5% and 45.1%, respectively, and 36.8%, 21.7% and 16.5% for microvascular diseases. Compared with participants who had progressed to diabetes during the trial, those who regressed to NGT had a 37% (HR 0.63; 95% CI 0.47, 0.85) reduction in CVD incidence and a median delay of 7.45 years (95% CI 1.91, 12.99) in onset, and those who remained with IGT had a 34% (HR 0.66; 95% CI 0.47, 0.91) lower CVD incidence with a median delay in onset of 5.69 years (95% CI 1.0, 10.38). Participants with NGT had a 66% (HR 0.34; 95% CI 0.20, 0.56) lower incidence of microvascular diseases and a median delay in the onset of 18.66 years (95% CI 6.08, 31.24), and those remaining with IGT had a 52% (HR 0.48; 95% CI 0.29, 0.81) lower incidence with a median delay of 12.56 years (95% CI 2.49, 22.63).
CONCLUSIONS/INTERPRETATION: People with IGT who reverted to NGT or remained with IGT at the end of the 6 year trial subsequently had significantly lower incidences of CVD and microvascular disease than those who had developed diabetes.
目的/假设：我们旨在确定在糖耐量正常（NGT）恢复、持续存在糖耐量受损（IGT）或进展为糖尿病的情况下，与随后发生心血管疾病（CVD）和微血管疾病的风险之间的关联，这些风险存在于中国 IGT 成年人中。
我们对来自大庆糖尿病预防研究的 540 名参与者进行了一项观察性研究，这是一项针对 IGT 人群的 6 年生活方式干预试验，根据 1985 年世界卫生组织标准，IGT 定义为空腹血糖<7.8mmol/l，负荷后 2 小时血糖≥7.8 且<11.1mmol/l。在试验结束时，确定了恢复到 NGT、持续存在 IGT 或进展为糖尿病的组。然后，在试验结束后的 24 年内对参与者进行随访，在此期间，我们比较了每组 CVD 和微血管疾病的发病率和危险比，并使用参数 Weibull 分布模型估计了从发病开始的中位时间差异。
在 6 年试验结束时，252 名（46.7%）参与者已发展为糖尿病，114 名（21.1%）持续存在 IGT，174 名（32.2%）已恢复到 NGT。与试验期间发生糖尿病的参与者相比，NGT 组和 IGT 组的糖尿病发病中位时间分别延迟了 14.86 年（95%CI 12.49，17.25）和 9.87 年（95%CI 8.12，11.68）。在试验结束后，对于患有糖尿病、IGT 和 NGT 的参与者，24 年的 CVD 累积发病率分别为 64.5%、48.5%和 45.1%，微血管疾病的发病率分别为 36.8%、21.7%和 16.5%。与试验期间进展为糖尿病的参与者相比，恢复到 NGT 的参与者 CVD 发病率降低了 37%（HR 0.63；95%CI 0.47，0.85），发病中位时间延迟了 7.45 年（95%CI 1.91，12.99），而持续存在 IGT 的参与者 CVD 发病率降低了 34%（HR 0.66；95%CI 0.47，0.91），发病中位时间延迟了 5.69 年（95%CI 1.0，10.38）。NGT 组微血管疾病的发病率降低了 66%（HR 0.34；95%CI 0.20，0.56），发病中位时间延迟了 18.66 年（95%CI 6.08，31.24），而持续存在 IGT 的参与者微血管疾病的发病率降低了 52%（HR 0.48；95%CI 0.29，0.81），发病中位时间延迟了 12.56 年（95%CI 2.49，22.63）。
结论/解释：在 6 年试验结束时恢复到 NGT 或持续存在 IGT 的 IGT 患者随后发生 CVD 和微血管疾病的风险显著低于发展为糖尿病的患者。
