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目的观察二甲双胍对糖耐量减低(IGT)人群转变成2型糖尿病转化率的作用以及对IGT逆转为正常糖耐量的作用。方法以口服葡萄糖(OGTT)试验,按1999年WHO标准确诊的IGT254例被随机分为两组,治疗组及对照组,每组127名,两组受试者的基本情况具有可比性。对照组按照中国营养学会制订的《中国居民膳食指南》中的饮食原则合理膳食,并适当增加体力活动;治疗组除给予相同内容的健康教育外,同时给予患者口服二甲双胍片,每日2次,每次0.5g。试验治疗期为2年。采用前瞻性对列研究的分析方法,计算治疗组和对照组的糖尿病累计发病率,并估计相对危险度。结果治疗2年后,34名IGT转变为糖尿病,其中治疗组和对照组分别为9例和25例,治疗组的糖尿病累积发病率为7.8%,对照组的糖尿病累积发病率为21.4%(P=0.004),相对危险度RR为0.366(95%可信区间0.179～0.750),治疗组和对照组逆转IGT到正常糖耐量的比例分别为56%和32.9%。结论采用二甲双胍干预治疗IGT是预防和延缓IGT向2型糖尿病发展的高效措施。
Objective To investigate the effect of metformin on the conversion rate of type 2 diabetes to impaired glucose tolerance (IGT) and the effect of converting IGT to normal glucose tolerance. Methods Oral glucose (OGTT) test, 254 cases of IGT diagnosed according to 1999 WHO standard were randomly divided into two groups, the treatment group and the control group, with 127 in each group. The basic conditions of the two groups were comparable. In accordance with the dietary principles of “Dietary Guidelines for Chinese Citizens” formulated by the Chinese Nutrition Society, the control group was given reasonable diet and physical activity was appropriately increased. In addition to giving the same content of health education, patients in the treatment group were given oral metformin tablets twice daily, Each 0.5g. Test treatment period of 2 years. Using a prospective analysis of the published studies, the cumulative incidence of diabetes in the treatment and control groups was calculated and the relative risk was estimated. Results After 2 years of treatment, 34 IGT patients were converted to diabetes. The treatment group and the control group were 9 and 25 respectively. The cumulative incidence of diabetes was 7.8% in the treatment group and 21.4% in the control group (P = 0.004). The relative risk (RR) was 0.366 (95% confidence interval 0.179-0.750). The ratio of IGT to normal glucose tolerance in treatment group and control group were 56% and 32.9%, respectively. Conclusion Metformin intervention in the treatment of IGT is an effective measure to prevent and delay the progression of IGT to type 2 diabetes mellitus.