Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group.
Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group.
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DOI：
10.2337/dc08-0494
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发表时间：
2009-04
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：
--
作者：
Goldberg RB;Temprosa M;Haffner S;Orchard TJ;Ratner RE;Fowler SE;Mather K;Marcovina S;Saudek C;Matulik MJ;Price D;Diabetes Prevention Program Research Group
虽然糖尿病患者患心血管疾病（CVD）的风险增加，但随着糖尿病前期患者进展为糖尿病，这种风险增加的演变尚不清楚。本研究考察了糖尿病预防计划的三个治疗组中选定的心血管疾病危险因素（血压、甘油三酯、HDL和LDL胆固醇以及LDL峰值颗粒密度[PPD]）与血糖之间的纵向关系。在随机分配到强化生活方式干预（ILS）、二甲双胍或安慰剂后，共有3234名糖耐量受损（IGT）的参与者被随访了平均3.2年。使用重复测量模型，对血糖状态的年变化进行调整后的危险因素平均水平的估计。还进行了测试，以评估血糖状况改善或恶化的危险因素趋势。随着糖耐量状态的恶化，CVD危险因素值和基线变化变得更加不利，但随着糖耐量（NGT）恢复正常而改善，尤其是在ILS干预组（除ILS组LDL PPD [P = 0.02]和安慰剂组HDL胆固醇[P = 0.02]外，所有危险因素的趋势检验P < 0.001）。虽然从IGT到糖尿病的转变没有什么显著差异，但危险因素和持续血糖测量之间存在很强的关系。从IGT到糖尿病的进展与轻度恶化有关，而向NGT的逆转与危险因素的改善有关。对糖尿病高危患者进行ILS早期干预，但二甲双胍干预效果较差，可同时改善心血管风险和葡萄糖耐量。
Although subjects with diabetes have increased risk for cardiovascular disease (CVD), the evolution of this increased risk as pre-diabetic individuals progress to diabetes is not understood. This study examines the longitudinal relationship between selected CVD risk factors (blood pressure, triglycerides, HDL and LDL cholesterol, and LDL peak particle density [PPD]) and glycemia in the three treatment groups of the Diabetes Prevention Program. A total of 3,234 participants with impaired glucose tolerance (IGT) were followed for a mean of 3.2 years after randomization to intensive lifestyle intervention (ILS), metformin, or placebo. Using repeated-measures models, adjusted mean levels of risk factors were estimated for an annual change in glycemic status. Tests were also conducted to assess the risk factor trends with improvement or worsening of glycemic status. CVD risk factor values and changes from baseline became more unfavorable as glucose tolerance status deteriorated but improved with reversion to normal glucose tolerance (NGT), especially in the ILS intervention group (trend test P < 0.001 for all risk factors except for LDL PPD [P = 0.02] in ILS and HDL cholesterol [P = 0.02] in placebo). Although there were few significant differences in the transition from IGT to diabetes, there were strong relationships between risk factors and continuous measures of glycemia. Progression from IGT to diabetes is associated with mild deterioration, whereas reversion to NGT is associated with improvement in risk factors. Early intervention with ILS, but less so with metformin, in participants at high risk for diabetes improves the cardiovascular risk and glucose tolerance profile simultaneously.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
影响因子：
37.8
作者：
Haffner, SM;Mykkänen, L;Stern, MP
通讯作者：
Stern, MP
影响因子：
7.7
作者：
Alexander, CM;Landsman, PB;Haffner, SM
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Haffner, SM
影响因子：
105.7
作者：
Stratton, IM;Adler, AI;Holman, RR
通讯作者：
Holman, RR
影响因子：
--
作者：
Borch-Johnsen, K;Neil, A;Qiao, Q
通讯作者：
Qiao, Q