Edelstein S L, Knowler W C, Bain R P, Andres R, Barrett-Connor E L, Dowse G K, Haffner S M, Pettitt D J, Sorkin J D, Muller D C, Collins V R, Hamman R F
George Washington University Biostatistics Center, Rockville, Maryland 20852, USA.
Diabetes. 1997 Apr;46(4):701-10. doi: 10.2337/diab.46.4.701.
Risk factors associated with the progression from impaired glucose tolerance (IGT) to NIDDM were examined in data from six prospective studies. IGT and NIDDM were defined in all studies by World Health Organization (WHO) criteria, and baseline risk factors were measured at the time of first recognition of IGT. The studies varied in size from 177 to 693 participants with IGT, and included men and women followed from 2 to 27 years after the recognition of IGT. Across the six studies, the incidence rate of NIDDM was 57.2/1,000 person-years and ranged from 35.8/1,000 to 87.3/1,000 person-years. Although baseline measures of fasting and 2-h postchallenge glucose levels were both positively associated with NIDDM incidence, incidence rates were sharply higher for those in the top quartile of fasting plasma glucose levels, but increased linearly with increasing 2-h postchallenge glucose quartiles. Incidence rates were higher among the Hispanic, Mexican-American, Pima, and Nauruan populations than among Caucasians. The effect of baseline age on NIDDM incidence rates differed among the studies; the rates did not increase or rose only slightly with increasing baseline age in three of the studies and formed an inverted U in three studies. In all studies, estimates of obesity (including BMI, waist-to-hip ratio, and waist circumference) were positively associated with NIDDM incidence. BMI was associated with NIDDM incidence independently of fasting and 2-h post challenge glucose levels in the combined analysis of all six studies and in three cohorts separately, but not in the three studies with the highest NIDDM incidence rates. Sex and family history of diabetes were generally not related to NIDDM progression. This analysis indicates that persons with IGT are at high risk and that further refinement of risk can be made by other simple measurements. The ability to identify persons at high risk of NIDDM should facilitate clinical trials in diabetes prevention.
在六项前瞻性研究的数据中，对与糖耐量受损（IGT）进展为非胰岛素依赖型糖尿病（NIDDM）相关的危险因素进行了研究。在所有研究中，IGT和NIDDM均按照世界卫生组织（WHO）标准定义，基线危险因素在首次确诊IGT时进行测量。这些研究的规模从177名至693名患有IGT的参与者不等，包括在确诊IGT后随访2至27年的男性和女性。在这六项研究中，NIDDM的发病率为57.2/1000人年，范围从35.8/1000至87.3/1000人年。尽管空腹和餐后2小时血糖水平的基线测量值均与NIDDM发病率呈正相关，但空腹血糖水平处于最高四分位数的人群发病率显著更高，而餐后2小时血糖四分位数升高时发病率呈线性增加。西班牙裔、墨西哥裔美国人、皮马人和瑙鲁人群中的发病率高于白种人。基线年龄对NIDDM发病率的影响在各项研究中有所不同；在三项研究中，发病率并未随基线年龄增加而升高或仅略有上升，而在三项研究中呈倒U形。在所有研究中，肥胖估计值（包括体重指数、腰臀比和腰围）与NIDDM发病率呈正相关。在所有六项研究的综合分析以及三项队列研究中，体重指数与NIDDM发病率相关，且独立于空腹和餐后2小时血糖水平，但在NIDDM发病率最高的三项研究中并非如此。性别和糖尿病家族史通常与NIDDM进展无关。该分析表明，IGT患者处于高风险，并且通过其他简单测量可以进一步细化风险评估。识别NIDDM高风险人群的能力应有助于糖尿病预防的临床试验。
