摘要目的 探讨不同体重新诊断2型糖尿病患者在接受标准化代谢性疾病管理6个月后的血糖转归情况.方法 (1)将163例新诊断2型糖尿病患者根据基线体重指数分为正常组(体重指数18.5～23.9 kg/m2)、超重组(体重指数24.0～27.9 kg/m2)和肥胖组(体重指数≥28 kg/m2),比较3组患者基线糖脂代谢情况.(2)所有患者均接受标准化的代谢性疾病管理,比较治疗6个月后的血糖控制情况.(3)在肥胖和超重患者中,根据治疗6个月后是否减重≥5％分成2组,比较2组患者治疗前后的血糖控制情况.结果 (1)基线时,与正常组相比,超重和肥胖组的胰岛素抵抗指数更高,高密度脂蛋白胆固醇更低.(2)经过6个月的治疗,在调整了基线HbA1C后,正常组、超重组、肥胖组的HbA1C水平及降幅无明显差异,HbA1C达标率(以HbA1C<7％为达标)分别为(77.78％对83.95％对80.43％,P>0.05).(3)治疗6个月后,32.28％的超重和肥胖患者减重≥5％.在调整了基线HbA1C值后,减重≥5％组与增重或减重<5％组间的HbA1C值均得到满意控制[(6.27±1.38对6.43±0.66)％],但差异无统计学意义(P>0.05).与增重或减重<5％组相比,减重≥5％组的HbA1C达标率更高(92.68％对77.91％,P<0.05).结论 随着体重指数的增加新诊断2型糖尿病患者的胰岛素抵抗和脂代谢紊乱更严重.经过6个月标准化管理后,不同基线体重和体重变化患者的血糖均获得良好控制.此外,减重≥5％能提高超重和肥胖患者的HbA1C达标率.

abstractsObjective To explore the glycemic control of newly-diagnosed type 2 diabetes with different levels of baseline body mass index ( BMI ) after 6 months treatment under the standardized metabolic disease management model. Methods ( 1) 163 patients of newly-diagnosed type 2 diabetes were divided into normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2), and obese (BMI≥28 kg/m2) groups according to baseline BMI, the blood glucose and lipids levels were compared among 3 groups. ( 2) The blood glucose levels were compared among 3 groups after 6 months of standardized management. ( 3) The overweight and obese patients were divided into group weight loss≥5％and group weight loss<5％ or weight gain in 6 months. The blood glucose levels were compared. Results ( 1) At baseline, overweight and obese groups had higher homeostasis model assessment for insulin resistance and lower high density lipoprotein-cholesterol compared with normal weight group. ( 2) After 6 months of treatment, HbA1C and HbA1C reduction showed no difference among 3 groups ( normal, overweight and obese) after adjusted by baseline HbA1C. The rate of HbA1C<7％among 3 groups were 77.78％, 83.95％, and 80.43％(P>0.05). (3) After 6 months of treatment, 32.28％ overweight and obese patients lost weight by ≥5％, while HbA1C and HbA1C reduction showed no difference between 2 groups ( weight loss≥5％and weight gain or weight loss<5％) after adjusted by baseline HbA1C. Both groups achieved good glycemic control [(6.27±1.38 vs 6.43±0.66)％], but have no significantly(P>0.05). Group weight loss≥5％ had better glucose control (92.68％ vs 77.91％, P<0.05) . Conclusions As BMI increased, insulin resistance and lipid disorders were more serious in newly-diagnosed type 2 diabetes. After 6 months of standardized metabolic management, newly-diagnosed type 2 diabetes with different baseline BMI and weight changes both achieved good glycemic control. In addition, patients losing weight equal to or more than 5％achieved higher attainment of HbA1C targets.