Davies M J, Raymond N T, Day J L, Hales C N, Burden A C
Department of Diabetes and Endocrinology, Leicester Royal Infirmary, UK.
Diabet Med. 2000 Jun;17(6):433-40. doi: 10.1046/j.1464-5491.2000.00246.x.
Use of the oral glucose tolerance test (OGTT) to define glucose intolerance in the general population may bias towards selection of those with insulin resistance. Beta cell function and insulin resistance markers were analysed in four groups: controls (n = 101); fasting hyperglycaemia (FH, n 45); impaired glucose tolerance; (IGT, n = 16) and those with features of both FH and IGT ('Both', n = 30).
Subjects underwent an OGTT. Plasma glucose, fasting lipid profiles, fasting, 30 and 120 min insulin were measured and beta cell function (% B) and insulin sensitivity (% S) assessed by homeostatic model assessment (HOMA) RESULTS: The FH group compared to controls had a significantly lower % B. The IGT group compared to controls had features of insulin resistance (higher body mass index (BMI), systolic blood pressure and 2 h insulin concentration). Subjects with 'both' IGT and FH had features of insulin resistance (higher BMI, systolic and diastolic blood pressure and triglyceride concentration) as well as beta cell dysfunction with a lower % B and 30 min insulin-glucose ratio compared to controls. There was a preponderance of males in this group. In all, 192 subjects' 30-min insulin concentration and incremental insulin response showed only a significantly negative correlation with fasting glucose concentration. In a linear regression analysis, a low 30-min insulin-glucose ratio was only a significant factor in the fasting glucose model. Thus, higher fasting glucose concentrations appear to be associated with beta cell dysfunction. However, HbA1 only showed a significant correlation with 120-min glucose, not fasting glucose concentration.
In those with milder degrees of glucose intolerance, FH is associated with beta cell dysfunction and those with IGT and a relatively 'normal' fasting glucose have features of the insulin resistance syndrome.
在普通人群中使用口服葡萄糖耐量试验（OGTT）来定义葡萄糖不耐受可能会偏向于选择那些具有胰岛素抵抗的人群。对四组人群的β细胞功能和胰岛素抵抗标志物进行了分析：对照组（n = 101）；空腹血糖过高（FH，n = 45）；糖耐量受损（IGT，n = 16）以及同时具有FH和IGT特征的人群（“两者兼具”，n = 30）。
受试者接受OGTT。测量血浆葡萄糖、空腹血脂谱、空腹、30分钟和120分钟胰岛素水平，并通过稳态模型评估（HOMA）评估β细胞功能（%B）和胰岛素敏感性（%S）。结果：与对照组相比，FH组的%B显著降低。与对照组相比，IGT组具有胰岛素抵抗特征（更高的体重指数（BMI）、收缩压和2小时胰岛素浓度）。与对照组相比，同时患有IGT和FH的受试者既有胰岛素抵抗特征（更高的BMI、收缩压和舒张压以及甘油三酯浓度），也有β细胞功能障碍，其%B和30分钟胰岛素 - 葡萄糖比值较低。该组男性占优势。总体而言，192名受试者的30分钟胰岛素浓度和胰岛素增量反应仅与空腹血糖浓度呈显著负相关。在线性回归分析中，低30分钟胰岛素 - 葡萄糖比值仅是空腹血糖模型中的一个显著因素。因此，较高的空腹血糖浓度似乎与β细胞功能障碍有关。然而，糖化血红蛋白（HbA1）仅与120分钟血糖呈显著相关，与空腹血糖浓度无关。
在葡萄糖不耐受程度较轻的人群中，FH与β细胞功能障碍有关，而IGT且空腹血糖相对“正常”的人群具有胰岛素抵抗综合征的特征。
