Objective To observe the protective effect of early intervention by lifestyle,metformin and rosigli-tazone on the siblings of patients of latent autoimmune diabetes in adults with impaired glucose regulation and positive insulin autoantibodies. Methods Totally 241 patients with LADA were randomly divided into control group,lifestyle intervention group,metformin group and rosiglitazone group. Patients in control group were not given lifestyle interven-tion and drug therapy,patients in lifestyle intervention group received diet and exercise guidance programs,and the pa-tients in metformin group and rosiglitazone group were given metformin 0. 5 g( three times daily) and rosiglitazone 4 mg ( once daily) on the basis of lifestyle intervention for 5 years. The height,weight,blood pressure,liver and kidney function,the fasting plasma glucose (FPG),2-hour plasma glucose (2hPG),fasting insulin (FINS) and C-peptide,2-hour insulin (2hINS) and C-peptide,glutamic acid decarboxylase antibodies (GADA),islet cell antibodies (ICA),in-sulin antibodies ( IAA) positive rate and the incidence of diabetes were recorded. Results Lifestyle intervention,met-formin and rosiglitazone could significantly improve the natural course of patients with prediabetes,and the patients in the three groups returned to 61. 9%,62. 7% and 66. 1% of normal glucose tolerance. The C-peptide and insulin of the 3 groups decreased slowly,insulin secretion index increased,and the incidence of patients progressing to LADA signifi-cantly decreased. Conclusion Lifestyle intervention,metformin and rosiglitazone has protective effects on the dysfunc-tion of pancreatic B cell;it can effectively reduce or delay the IFG,IGT and IFG united IGT progressing to LADA in the positive ICA siblings of LADA patients.%目的：观察生活方式、二甲双胍及罗格列酮早期干预对成人隐匿性自身免疫性糖尿病( LADA)患者的糖调节受损且胰岛自身抗体阳性同胞的保护效应。方法将符合标准的241例患者分为自然转归组、生活方式干预组、二甲双胍干预组、罗格列酮干预组。自然转归组不愿进行生活方式干预及药物治疗；生活方式干预组：提供书面饮食、运动指导方案；二甲双胍干预组：在生活方式干预的基础上,服用二甲双胍0．5 g,3次/d；罗格列酮干预组：在生活方式干预的基础上,服用罗格列酮4 mg,1次/d。干预治疗5年。记录患者的身高、体重、血压、肝肾功能、空腹血糖(FPG)、葡萄糖负荷后2 h血糖(2hPG)、空腹胰岛素(FINS)和C肽、葡萄糖负荷后2 h胰岛素(2hINS)和C肽、谷氨酸脱羧酶抗体(GADA)、胰岛细胞抗体(ICA)、胰岛素抗体(IAA)阳性率及糖尿病发生率。结果生活方式干预、二甲双胍及罗格列酮可显著改善糖尿病前期患者的自然病程,三组分别恢复为正常糖耐量的61．9%、62．7%及66．1%。三组胰岛B细胞功能(空腹、负荷后2 h)中,C肽、胰岛素降低,胰岛素分泌指数增加,进展为LADA的发病率降低。结论生活方式、二甲双胍及罗格列酮干预对胰岛B细胞功能损伤具有保护效应,能有效减少或延缓LADA患者胰岛细胞抗体阳性同胞的空腹血糖受损( IFG)、葡萄糖耐量受损( IGT)、IFG合并IGT患者进展为LADA。
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