摘要目的 探讨糖尿病高危人群强化生活方式干预6年内恢复正常血糖对长期糖尿病发病风险的影响.方法 1986年大庆市577例糖耐量减低(IGT)者被随机分到对照组和饮食、运动或饮食加运动组进行6年生活方式干预,观察早期糖耐量改善对该人群长期血糖演变的影响.结果 干预结束后原IGT人群6年内转化为糖耐量正常(NGT)者2006年时41.38％仍可保持NGT状态,恶化为糖尿病者比例,转化为NGT者远低于仅维持IGT状态者(46.55％比75.25％).干预组中转为NGT者长期随访中演变为糖尿病比例远低于仍然维持IGT者(43.71％比76.25％).调整年龄、性别和基线血糖影响后,干预组维持1GT者较转化为NGT者发生糖尿病风险高(HR=1.81,95％CI 1.27～2.58,P=0.001).而非干预组中仍维持IGT及恢复为NGT者其后14年恶化为糖尿病风险相似(71.43％比65.22％),调整上述影响因素后两者发生糖尿病的风险也无明显差别(HR=1.03,95％C10.45～2.35,P=0.94).结论 IGT人群中早期逆转为NGT比仅仅维持IGT状态对预防糖尿病有益,然而这种预防糖尿病的长期获益仅见于干预组,提示只有经主动干预恢复正常才对糖尿病预防有长期的后效应.

abstractsObjective To explore the influence of lifestyle intervention on long-term diabetes in subjects with impaired glucose tolerance (IGT) returned to normal glucose tolerance (NGT) within 6 years.Methods A total of 577 subjects (aged 25-74 years old) with IGT in Daqing were enrolled and randomly assigned to control,and diet,exercise and diet plus exercise groups in a six-year intervention trial in 1986.Subjects who were non-diabetic at the end of the intervention were followed up for additional 14 years.Results Among all the subjects,41.38％ of them who had returned to NGT from IGT within 6 years maintained NGT status after 20 years,and had a lower incidence of diabetes than subjects maintained IGT status (46.55％ vs.75.25％).Of note,in the intervention group,the percentage of participants developed diabetes in the NGT subjects was significantly lower than that in the IGT group (43.71％ vs.76.25％) after 20 years.There was high long-term risk for diabetes in the IGT subjects after the adjustment of age,sex and baseline glucose (HR=1.81,95％CI 1.27-2.58,P=0.001),whereas in the non-intervention group,no significant difference could be viewed in long-term diabetic risk between subjects maintained IGT status and those returned to NGT (71.43％ vs.65.22％) after adjusting of the same confounders (HR=1.03,95％CI 0.45-2.35,P=0.94).Conclusions IGT subjects who had returned to NGT in early years had lower risk for future diabetes than those who remained IGT.However,this beneficial effect could only be viewed in the intervention group,but not in the non-intervention group.