5  日本糖尿病并发症研究（The Japan Diabetes Complications Study，JDCS）

    JDCS是随机、对照、多中心、前瞻性、干预性临床研究。由日本59个糖尿病专科门诊研究机构参与。目的是确定生活方式的干预能否促进2型糖尿病患者血糖控制和阻止并发症发生［31］。

    JDCS的研究对象为2205例诊断的NIDDM患者。40～70岁，平均年龄59.4岁,平均糖尿病病程11.3年,HbA1c6.5%以上，平均HbA1c7.74%。

    JDCS对研究者进行干预，对每一个门诊患者就诊时进行强化生活方式干预和经常电话咨询。干预组接受有关生活方式和行为改变重要性的指导资料，包括指导饮食疗法、运动、控制吸烟、用药物疗法对高血压进行治疗。糖尿病自我管理教育（diabetes self-management education,DSME）是其中的重要内容之一，其目的是：获得理想的代谢控制，防止急、慢性并发症，获得理想的生活质量，减少医疗费用。常规治疗组接受常规治疗。每年查血脂、血压、微血管（视网膜、肾脏、神经病变）并发症和大血管并发症等项内容。

    JDCS按饮酒将患者分为3个组，比较6年后冠心病、卒中发病情况和其他的特征。结果：和白种人比较，日本NIDDM患者肥胖较少，冠心病发病率较低。实验开始时HbA1c在干预组为（7.68±1.28）%，对照组为（7.80±1.42）%。在干预开始2年后，HbA1c水平在两组之间出现有意义的差异，对照组为（7.78±1.27）%，干预组为（7.62±1.20）%。并且维持到第三年［32］。

    由冠心病引起的死亡率，在干预终止后7年，两组之间没有差异，但10.5年后，干预组减少至10.6%，呈有意义降低，至16年后，两组差异仍然存在。性别、LDL胆固醇、HbA1c、三酸甘油酯是NIDDM患者心衰的危险因素，而收缩压和HbA1c是脑卒中的危险因素。NIDDM冠心病和卒中事件比非糖尿病患者高3倍以上［33］。卒中发病在重度饮酒组比较高，血三酸甘油酯水平增加与卒中呈平行。少量饮酒和不饮酒患者卒中发病率没有差异。饮酒和冠心病之间的关系不明确。

    6  结论

    对2型糖尿病患者进行生活方式的干预，可以促进血糖的控制。生活习惯的干预应包括多种危险因素的干预，其效果的出现要有一个较长的时间［27］。对各种危险因素的控制，如LDL胆固醇、血压和血糖，对防止日本人NIDDM患者心脑血管并发症有重要的价值。重度饮酒的日本糖尿病患者卒中发病明显增高。

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    作者单位： 210029 江苏南京，南京医科大学第一临床医学院眼科

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