Ran J, Cheng H, Li F
Endocrinology Department, Memorial Hospital, Sun Yat-Sen University of Medical Sciences, Guangzhou 510120, China.
Zhonghua Yi Xue Za Zhi. 2000 Jan;80(1):38-41.
To investigate the characteristics of insulin secretion rate (ISR), metabolic clearance rate (MCR-I) and sensitivity and to explore their relationship with obesity in non-insulin-dependent diabetic subjects from multiplex diabetic pedigrees (MDP).
Fifteen subjects with normal glucose tolerance and 11 non-insulin-dependent diabetic patients from MDP were included in the study. Frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed. Glucose, insulin (INS) and connecting-peptide (C-P) concentrations were measured. A computer procedure devised by our laboratory was used to calculate the value of ISR at each time point, then MCR-I was acquired. Insulin sensitivity index (SI) was calculated according to minimal model technique about glucose in FSIVGTT.
The ISR curve in control group was biphasic, while in non-insulin. In non-insulin-dependent diabetic group, areas under the curves of C-P (AUCC) and ISR level (AUCS) measured during 0 approximately 16 min were 7.9 nmol.min(-1).L(-1) +/- 2.8 nmol.min(-1).L(-1), and 6.1 nmol +/- 2.2 nmol, respectively, which were significantly lower than those in control group 17.7 nmol.min(-1).L(-1) +/- 4.92 nmol.min(-1).L(-1) and 12.3 nmol +/- 3.9 nmol (P < 0.01). The two parameters were slightly higher than those in control group 155 nmol.min(-1).L(-1) +/- 44 nmol.min(-1).L(-1) vs 101 nmol.min(-1).L(-1) +/- 30 nmol.min(-1).L(-1) and 76 nmol +/- 26 nmol vs 54 nmol +/- 20.0 nmol (P < 0.05)measured during 16 approximately 180 min. There was no significant difference, between the two groups about the amount of insulin secretion during 3 hours (82 nmol +/- 28nmol vs 68 nmol +/- 21 nmol, P = 0.2). In control group, there were significant positive correlation, between AUCS, waist-hip ratio (WHR), and body surface area, (BSA) and significant negative correlation between MCR-I, SI and WHR, BSA (P < 0.01), and also between MCR-I and SI. In non-insulin-dependent diabetic group, AUCS were significantly correlated with body mass index (BMI) (P < 0.01), and MCR-I had significant negative correlation with AUCC (P < 0.01).
There are obvious impaired first phase insulin secretion after glucose challenge in non-insulin-dependent diabetic subjects from MDP. Decrease in endogenous MCR-I might be an important factor to hyperinsulinemia and insulin resistance. Increased insulin secretion, decreased MCR-I and insulin sensitivity can be observed in abdominal obese subjects of control group.
研究多重糖尿病家系（MDP）中非胰岛素依赖型糖尿病患者的胰岛素分泌率（ISR）、代谢清除率（MCR-I）及敏感性特点，并探讨它们与肥胖的关系。
本研究纳入15例糖耐量正常者及11例来自MDP的非胰岛素依赖型糖尿病患者。进行频繁取样静脉葡萄糖耐量试验（FSIVGTT）。测定血糖、胰岛素（INS）及连接肽（C-P）浓度。使用我们实验室设计的计算机程序计算各时间点的ISR值，进而得出MCR-I。根据FSIVGTT中葡萄糖的最小模型技术计算胰岛素敏感性指数（SI）。
对照组的ISR曲线呈双相，而非胰岛素依赖型糖尿病组的ISR曲线并非如此。在非胰岛素依赖型糖尿病组中，0至16分钟期间测得的C-P曲线下面积（AUCC）和ISR水平（AUCS）分别为7.9 nmol·min⁻¹·L⁻¹±2.8 nmol·min⁻¹·L⁻¹和6.1 nmol±2.2 nmol，显著低于对照组的17.7 nmol·min⁻¹·L⁻¹±4.92 nmol·min⁻¹·L⁻¹和12.3 nmol±3.9 nmol（P<0.01）。在16至180分钟期间测得的这两个参数略高于对照组（155 nmol·min⁻¹·L⁻¹±44 nmol·min⁻¹·L⁻¹对101 nmol·min⁻¹·L⁻¹±30 nmol·min⁻¹·L⁻¹，76 nmol±26 nmol对54 nmol±20.0 nmol，P<0.05）。两组在3小时内的胰岛素分泌量无显著差异（82 nmol±28 nmol对68 nmol±21 nmol，P = 0.2）。在对照组中，AUCS与腰臀比（WHR）、体表面积（BSA）呈显著正相关，MCR-I、SI与WHR、BSA呈显著负相关（P<0.01），且MCR-I与SI之间也呈显著负相关。在非胰岛素依赖型糖尿病组中，AUCS与体重指数（BMI）显著相关（P<0.01），MCR-I与AUCC呈显著负相关（P<0.01）。
MDP中的非胰岛素依赖型糖尿病患者在葡萄糖刺激后存在明显的早期胰岛素分泌受损。内源性MCR-I降低可能是高胰岛素血症和胰岛素抵抗的重要因素。在对照组的腹型肥胖受试者中可观察到胰岛素分泌增加、MCR-I降低及胰岛素敏感性降低。
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