Eriksson K F, Lindgärde F
Department of Medicine, University Hospital, Malmö, Sweden.
Diabetologia. 1998 Sep;41(9):1010-6. doi: 10.1007/s001250051024.
Impaired glucose tolerance (IGT) is associated with increased mortality due to ischaemic heart disease (IHD), but as it is not known whether this excess mortality can be reduced by preventing or delaying the development of non-insulin-dependent diabetes mellitus (NIDDM), a long-term NIDDM prevention trial of dietary counselling and physical exercise was launched at Malmö, Sweden, the 12-year follow-up of which is reported here. At 12-year follow-up of 6956 men who underwent health screening at 48 years of age, an IGT intervention group (n = 288) who participated in a long-term NIDDM prevention programme were compared with an IGT non-randomised routine treatment group (n = 135), a diabetic group (n = 144), and the remainder, the normal glucose tolerance (NGT) group (n = 6389). The variables studied included the levels of blood glucose, plasma insulin, blood pressure, blood lipids, lung function and maximum oxygen uptake. Subjects with IGT were characterised by overweight, poor vital capacity, hypertension, hypertriglyceridaemia and hyperinsulinaemia. The mortality rate in the IGT intervention group was similar to that in the NGT group (6.5 vs 6.2 per 1000 person years at risk) and lower than that in the IGT routine treatment group (6.5 vs 14.0, p = 0.009). In the two IGT groups taken together, intervention but not body mass index, systolic blood pressure, smoking, cholesterol or the 2-h glucose level predicted mortality. Systolic blood pressure was a predictor of IHD mortality among IGT subjects; and in the cohort as a whole, body mass index, systolic blood pressure, hypercholesterolaemica, diabetes and smoking were predictors of IHD mortality. The findings suggest that a long-term intervention programme, with an emphasis on lifestyle changes, including dietary counselling and physical exercise, will reduce mortality in subjects with IGT who are at an increased risk of both developing NIDDM and of premature death due to IHD and other causes.
糖耐量受损（IGT）与缺血性心脏病（IHD）导致的死亡率增加相关，但由于尚不清楚通过预防或延缓非胰岛素依赖型糖尿病（NIDDM）的发生是否可以降低这种额外的死亡率，因此在瑞典马尔默开展了一项关于饮食咨询和体育锻炼的长期NIDDM预防试验，本文报告了该试验的12年随访结果。在对6956名48岁接受健康筛查的男性进行12年随访时，将参与长期NIDDM预防计划的IGT干预组（n = 288）与IGT非随机常规治疗组（n = 135）、糖尿病组（n = 144）以及其余的正常糖耐量（NGT）组（n = 6389）进行了比较。所研究的变量包括血糖、血浆胰岛素、血压、血脂、肺功能和最大摄氧量。IGT受试者的特征为超重、肺活量差、高血压、高甘油三酯血症和高胰岛素血症。IGT干预组的死亡率与NGT组相似（每1000人年风险中分别为6.5和6.2），且低于IGT常规治疗组（6.5对14.0，p = 0.009）。将两个IGT组合并来看，干预而非体重指数、收缩压、吸烟、胆固醇或2小时血糖水平可预测死亡率。收缩压是IGT受试者中IHD死亡率的一个预测因素；在整个队列中，体重指数、收缩压、高胆固醇血症、糖尿病和吸烟是IHD死亡率的预测因素。研究结果表明，一项强调生活方式改变（包括饮食咨询和体育锻炼）的长期干预计划将降低IGT受试者的死亡率，这些受试者患NIDDM以及因IHD和其他原因过早死亡的风险增加。
