Regression from pre-diabetes to normal glucose regulation in the diabetes prevention program.
Regression from pre-diabetes to normal glucose regulation in the diabetes prevention program.
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DOI：
10.2337/dc09-0523
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发表时间：
2009-09
期刊：
影响因子：
16.2
通讯作者：
Diabetes Prevention Program Research Group
中科院分区：
文献类型：
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作者：
Perreault L;Kahn SE;Christophi CA;Knowler WC;Hamman RF;Diabetes Prevention Program Research Group
糖尿病预防计划（DPP）的参与者随机分配到强化生活方式改变组（ILS）或二甲双胍组，与随机分配到安慰剂组的参与者相比，糖尿病的发病率显著降低，但大多数人仍然有糖尿病前期的风险。我们探讨了基线特征、体重变化、ILS和二甲双胍对糖尿病前期回归到美国糖尿病协会标准定义的正常葡萄糖调节（NGR）最低风险状态的影响。DPP是一项前瞻性随机试验。采用Cox比例风险模型确定3年随访期间糖尿病前期回归到NGR的预测因素。较低的基线空腹（风险比1.52,P < 0.01）和2小时血糖（风险比1.24,P < 0.01）预测NGR的回归，较年轻（风险比1.07,P < 0.01）和较高的胰岛素分泌（风险比1.09,P = 0.04）预测NGR的回归。ILS （2.05, P < 0.01）和体重减轻（1.34,P < 0.01）对回归有显著且独立的影响。二甲双胍（1.25,P = 0.06）、男性（1.17,P = 0.08）和胰岛素敏感性（1.07,P = 0.09）也有不显著的回归趋势。在空腹血糖（IFG）和糖耐量（IGT）均受损的患者中，男性性别和胰岛素敏感性预测向分离的IFG回归，而ILS、二甲双胍、女性性别和胰岛素分泌增加预测向分离的IGT回归。胰岛素分泌和其他随年龄增长而保留的生物过程是糖尿病前期患者恢复NGR的关键。然而，NGR也可以通过减肥和ILS的其他方面来实现。
Participants in the Diabetes Prevention Program (DPP) randomized to intensive lifestyle modification (ILS) or metformin had a significantly reduced incidence of diabetes compared with those randomized to placebo, yet most were still at risk because they had pre-diabetes. We explored the effect of baseline characteristics, weight change, ILS, and metformin on regression from pre-diabetes to the lowest-risk state of normal glucose regulation (NGR) defined by American Diabetes Association criteria. The DPP was a prospective randomized trial. Cox proportional hazards modeling was used to identify predictors of regression from pre-diabetes to NGR over 3 years of follow-up. Lower baseline fasting (hazard ratio 1.52, P < 0.01) and 2-h (1.24, P < 0.01) glucose predicted regression to NGR, as did younger age (1.07, P < 0.01) and greater insulin secretion (1.09, P = 0.04). ILS (2.05, P < 0.01) and weight loss (1.34, P < 0.01) had significant and independent effects on regression. A nonsignificant trend for regression was also observed for metformin (1.25, P = 0.06), male sex (1.17, P = 0.08), and insulin sensitivity (1.07, P = 0.09). In those entering the study with both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), male sex and insulin sensitivity predicted regression to isolated IFG, whereas ILS, metformin, female sex, and greater insulin secretion predicted regression to isolated IGT. Insulin secretion, and other biologic processes retained with younger age, are key in restoring NGR in people with pre-diabetes. However, NGR may also be attained through weight loss and additional aspects of ILS.