糖耐量正常人群糖负荷后血糖变化幅度大 是代谢性疾病的危险因素并可预测 糖尿病的发生

Objective We aimed to explore the relationship between the change amplitude of glycemic and metabolic syndrome after glucose load in normal glucose tolerance (NGT) people. Methods According to the World Health Organization diabetes diagnostic criteria, a total of 22 302 NGT subjects with complete data were screened from the China National Diabetes and Metabolic Disorders Study (CNDMDS) from 2007 to 2008. The absolute difference between 2 h post-load glucose (2hPG) and fasting plasma glucose (FPG) during oral glucose tolerance test (OGTT) was used to reflect the change amplitude of glycemic, and compare the differences of metabolic indices and the prevalence of metabolic syndrome between different change amplitude. As a part of CNDMDS, 3 247 subjects completed the baseline survey from 2007 to 2008 in Shaanxi Province, in the retrospective cohort to 2016 and 2017, a total of 678 NGT subjects with complete data were included in the confirmatory analysis. According to the cut-off point of the change amplitude of glycemic related to metabolic diseases from the receiver operating characteristic curve (ROC) in the cross-sectional analysis, subjects were divided into two groups to compare the incidence risk of diabetes after 9 years of follow-up. The t test, analysis of variance and chi-square test were used to compare the differences in clinical characteristics and metabolic indices among different groups, and Logistic regression analysis was used to evaluate the influence of different groups on the prevalence of MS and the incidence of diabetes. Results We divided the change amplitude of glycemic after glucose load of 22 302 subjects into quartiles, among which the change amplitude were as follows: Q1 group (<0.45 mmol/L, 5 593 subjects), Q2 group (0.45 to 0.93 mmol/L, 5 603 subjects), Q3 group (0.94 to 1.60 mmol/L, 5 636 subjects), Q4 group (>1.60 mmol/L, 5 470 subjects); the body mass index (BMI), waist circumference, blood pressure, total cholesterol, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were increased significantly with the increasement of the change amplitude of glycemic, while high-density lipoprotein cholesterol (HDL-C) decreased significantly, the prevalence of metabolic syndrome (MS) and the proportion of subjects with middle or high risk for developing coronary heart disease in 10 years [Framingham risk score (FRS) ≥10%] were increased significantly. Logistic regression analysis showed that the large change amplitude of glycemic after glucose load was a risk factor for MS. Use MS and FRS ≥10% as the outcome variables, the change amplitude of glycemic as the independent variable, the cut-off point of the change amplitude of glycemic both were 1.09. Among 678 NGT subjects in the retrospective cohort, the incidence of diabetes in the group with small change amplitude of glycemic (the change amplitude of glycemic ≤1.09 mmol/L) and large change amplitude of glycemic (the change amplitude of glycemic >1.09 mmol/L) were 7.2% (28/388) and 13.1% (38/290), respectively, the difference was statistically significant (P=0.011). Logistic regression analysis showed that the change amplitude of glycemic after glucose load >1.09 mmol/L was a risk factor for diabetes, after adjusting for age, gender, BMI, smoking, drinking, exercise and family history of diabetes, the risk ratio was 1.829 (95%CI 1.079 to 3.101, P=0.025). Conclusion In NGT people, the large change amplitude of glycemic after glucose load was a risk factor for metabolic diseases and could predict the occurrence of diabetes. [ABSTRACT FROM AUTHOR]