目的:评估口服葡萄糖耐量试验期间测定的空腹血糖(FPG)与2小时负荷后血糖(2hPG)之间的关系,以及中国成年人患糖尿病的风险。
方法:我们追踪了3,094名没有糖尿病的参与者,根据口服葡萄糖耐量试验(OGTT)结果将它们分为基线时的低负荷后(2hPG≤FPG)和高负荷后(2hPG>FPG).我们监测了糖尿病的发病率,糖尿病前期的发病率,在平均3.2年的随访中,从糖尿病前期到糖尿病的疾病进展和从糖尿病前期到正常葡萄糖耐量(NGT)的疾病逆转。在Schoenfeld剩余测试之后,Cox的时变协变量(Cox-TVC)模型用于评估风险比(HR)和95%置信区间(CI),以比较低负荷组和高负荷组之间的不同临床事件。
结果:在队列研究中,在3,094名参与者中,702(22.7%)具有较低的后负荷(2hPG≤FPG,平均负荷后-空腹差距:-0.8±0.7mmol/L)和2,392(77.3%)具有高负荷后(2hPG>FPG,平均负荷后空腹间隙:1.8±1.2mmol/L)。超过3.2±0.2年的随访,282人(9.1%)发展为糖尿病。在低负荷后组中,每1,000人年的发病率为:糖尿病为7.9,糖尿病前期为70.0,从糖尿病前期到糖尿病的疾病进展为23.4,NGT的疾病逆转为327.2.对于高后荷载组,糖尿病的发病率为13.9,糖尿病前期为124.3,疾病进展为59.5,疾病逆转为238.6/1,000人年.高负荷后的参与者表现出更高的糖尿病发病率,前驱糖尿病,与低负荷患者相比,从糖尿病前期到糖尿病的进展。糖尿病和糖尿病前期患者的HR显著升高,从糖尿病前期到糖尿病的疾病进展,而疾病逆转率较低。
结论:在具有高负荷后的参与者中,在3.2年的随访后发生前驱糖尿病/糖尿病的风险更高。这表明,负荷后-空腹差距可能是一个简单的工具来预测患糖尿病前期的风险,糖尿病或逆转NGT。
OBJECTIVE: To evaluate the relationship between fasting plasma glucose (FPG) and 2-hour postload plasma glucose (2hPG) measured during an oral glucose tolerance test, and the risk of developing diabetes in Chinese adults.
METHODS: We followed 3,094 participants without diabetes, categorizing them based on their oral glucose tolerance test (OGTT) results into low post load (2hPG ≤ FPG) and high post load (2hPG > FPG) at baseline. We monitored the incidence of diabetes, incidence of prediabetes, disease progression from prediabetes to diabetes and disease reversal from prediabetes to normal glucose tolerance (NGT) over an average of 3.2 years of follow-up. After the Schoenfeld residual test, Cox\'s time-varying covariate (Cox-TVC) models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) to compare the different clinical events between low and high post load groups.
RESULTS: In the cohort study, of the 3,094 participants, 702 (22.7 %) had low post load (2hPG ≤ FPG, mean postload-fasting gap: -0.8 ± 0.7 mmol/L) and 2,392 (77.3 %) had high post load (2hPG > FPG, mean postload-fasting gap: 1.8 ± 1.2 mmol/L). Over 3.2 ± 0.2 years of follow-up, 282 (9.1 %) developed diabetes. In the low post load group, the incidence rates per 1,000 person-years were: diabetes was 7.9, prediabetes was 70.0, disease progression from prediabetes to diabetes was 23.4 and disease reversal to NGT was 327.2. For the high post load group, incidence rates for diabetes was 13.9, prediabetes was 124.3, disease progression was 59.5 and disease reversal was 238.6 per 1,000 person-years. Participants with high post load showed higher incidence rates of diabetes, prediabetes, and progression from prediabetes to diabetes compared to those with low post load. HRs were significantly higher for incident diabetes and prediabetes, and disease progression from prediabetes to diabetes, whereas disease reversal was lower.
CONCLUSIONS: The risk of developing prediabetes/diabetes after 3.2 years of follow-up was higher in the participants with high post load. It suggested that postload-fasting gap may be a simple tool to predict the risk of developing prediabetes, diabetes or reversal to NGT.