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目的评价生活方式干预对中国城市社区糖调节异常人群的效果。方法随机整群抽取上海黄浦区2个社区,将社区232名>35岁糖调节异常居民随机分配至运动干预组(58人)、膳食干预组(57人)、综合干预(运动+膳食)组(59人)和对照组(58人),接受6个月的干预。在研究开始和结束时对所有研究对象进行体格检查和生化指标检测(包括空腹血糖、OGTT、HbA1c、总胆固醇等)。结果与对照组相比,无论是运动干预、膳食干预还是两者结合的综合干预,社区IGR居民的空腹血糖、OGTT、HbA1c、总胆固醇、BMI、WHR和血压均明显降低(P<0.05);运动干预组和综合干预组血脂的降低亦有统计学差异(P<0.05);高密度脂蛋白只有综合干预组观察到了有统计学意义的增加(P<0.05);而不同干预组之间低密度脂蛋白的改变均未发现统计学差异。对照组的糖尿病6个月累积发病率为8.6%,而各干预组中均未发现糖尿病,差别有统计学意义(Fisher精确P=0.002);对照组6个月累积的血糖转为正常率为3.4%,低于各干预组(分别为8.6%,14.0%和16.9%),但是只有综合干预组的差别有统计学意义(OR=5.74,95%CI1.19～27.64,P=0.029)。结论短期生活方式干预可以改善上海市社区糖调节异常居民的代谢相关指标,降低糖尿病的发病风险和促进向正常血糖转化,特别是综合干预措施效果明显。
Objective To evaluate the effect of lifestyle intervention on people with abnormal glucose regulation in Chinese urban communities. Methods Two groups of community-based residents with abnormal glucose regulation of 35 years old were randomly allocated to exercise intervention group (58 persons), dietary intervention group (57 persons), comprehensive intervention (exercise + diet group) (59) and control group (58) received six months of intervention. Physical examination and biochemical tests (including fasting blood glucose, OGTT, HbA1c, total cholesterol, etc.) were performed on all subjects at the beginning and end of the study. Results Compared with the control group, fasting blood glucose, OGTT, HbA1c, total cholesterol, BMI, WHR and blood pressure of community IGR residents were significantly lower than those of control group (P <0.05), no matter exercise intervention, dietary intervention or combination of both. There was also a statistically significant difference between the intervention group and the comprehensive intervention group (P <0.05). Only high-density lipoprotein (HDL) showed a statistically significant increase (P <0.05) in the comprehensive intervention group, while the difference between the low- No significant difference was found in the changes of HDL. The cumulative incidence of diabetes 6 months in the control group was 8.6%, while no diabetes was found in each intervention group, the difference was statistically significant (Fisher exact P = 0.002); the control group 6 months cumulative blood glucose to normal rate 3.4%, lower than the intervention group (8.6%, 14.0% and 16.9% respectively), but only the comprehensive intervention group was statistically significant (OR = 5.74,95% CI 1.19-27.64, P = 0.029). Conclusion Short-term lifestyle intervention can improve the metabolism-related indicators of residents with abnormal glucose regulation in Shanghai, reduce the risk of diabetes and promote the conversion to normal blood glucose, especially the comprehensive intervention.