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1、2型糖尿病一级预防 糖尿病高危(IGT)人群的干预,中日友好医院 李光伟,IDF 主席开幕式演讲 YESTERDAY, TODAYAND TOMORROWKGMM AlbertiPrevention, Prevention and Prevention,X 综合征 死亡四重奏 （Reaven,1988） （Kaplan,1989）,胰岛素抵抗 中心性肥胖 糖耐量低减/DM 糖耐量低减/DM 高胰岛素血症 高TG血症 高TG血症 低HDL-c血症 高血压 高血压胰岛素抵抗综合征（DeFronzo, 1991） 代 谢 综 合 征（Zimmet, 1997）,Insulin Resistance,
2、Hypertension,Type 2 Diabetes,The metabolic syndrome of insulin resistance & cardiovascular disease,Reduced Fibrinolysis,Complex dyslipidemia TG, sdLDL HDL,Endothelial Dysfunction,Chronic systemic Inflammation,Athero- sclerosis & CHD,Visceral Obesity,2型糖尿病一级预防糖尿病高危(IGT)人群的干预历史的回顾大庆糖尿病预防研究的由来当前2型糖尿病预防
3、研究的局限及尚未能解决和正在解决的问题,一. 历史的回顾,Prevention is better than cure,糖尿病一级预防研究对象 干预措施 大庆研究 IGT 生活方式 DPP IGT 生活方式+双胍 DPS IGT 生活方式 STOP-NIDDM IGT 阿卡波糖,大庆研究中糖尿病每百人年发病率,11.5,10.8,11.4,17.2,饮食组,运动组,饮食+运动,对照组,BMI=25,5.1,6.8,13.3,8.3,饮食组,运动组,饮食+运动,对照组,BMI100,例,多因素分析,胰岛素抵抗对干预疗效分析,目的,（大庆）研究是为了在某一特定人群（IGT)，采取某一特定的方法(生
4、活方式干预），证明某种假设（生活方式干预可预防糖尿病的发生）的正确 (合理性和可行性）。然后以这种假设去说服人,让人们采取行动解决问题。（大庆）研究是为了改变现状（降低中国乃至世界的糖尿病发病率,当时并未提出代谢综合征）。,三.当前2型糖尿病预防研究的局限及尚未能解决和正在解决的问题,生活方式干预预防糖尿病 合理性 成本效益? 对预防心脑血管病是否有益? 可行性 多少人能长期坚持?,药物干预预防糖尿病的合理性和可行性 最佳剂量？ 成本效益? 耐受性？ 毒副作用? 预防了糖尿病or 提前治疗?,Unanswered Questions,How to conduct the screening?
5、One step or two-steps? OGTT or standard meal test?How to do the prevention? Lifestyle or pharmacological? HOW to translate these successful findings in Da-Qing Study DPP and DPS and maintain the lifestyle changes in longer term Targeting insulin resistance or insulin insufficiency? Prevent diabetes
6、or reverse to normal tolerance?Standard protocol or tailored one? How To Increase Effectiveness and Reduce Cost?,Lifestyle or Medication?,Method of intervention,Diet Group: BMI 25 reduce calorie intake to reduce weight 0.5-1.0 kg/month Exercise Group: To increase amount of leisure physical exercise
7、by at least one unit. Diet and Exercise Group: Same as Diet and Exercise group Controls: Only exposed to general information about DM from public health education. No special advice.,Table 1. Exercise units,Each category represents one unit,Lifestyle: How Intensive is Effective?,Da-Qing Study :At le
8、ast decrease 50 gm of Carbohydrate/dayat least increase 50 min physical exercise/day5 days/weekDiabetes Prevention Program:Weight loss 7% and exercise 150min/weekDiabetes Prevention Study:Weight loss 5% and exercise 4 hours/week,Efficacy of lifestyle intervention Comparison of Da-Qing Study to DPP a
9、nd DPS,Q: Should The Chinese Need to Use Protocol in DPP or DPS in Their Future Prevention? A: Yes ? No! Yes or no!Weight loss 7% Trail for Prevention DM with lifestyle modification in USTrail for weight loss with medication (orlistat) in ChineseLifestyle Olistat Weight Reduction (Kg) 3.00 6.05 Weig
10、ht Reduction (%) 3.67 7.45,过强的生活方式干预会大大增加退出干预的人数，中等强度的干预才能既有效又能为广大人群接受并常年坚持。,DA-QING STUDY 未采用过于激烈的强度大的干预，失访率仅8%.DPP，DPS体重减轻第一年达标率27?) No, For most non-obese Chinese IGT, less intensive prevention protocol than DPP may be working if only for preventing DM, however reversing them to normal glucose tolerance more intensive prevention protocol is needed.,Pharmacological Intervention,
