Kriketos A D, Carey D G, Jenkins A B, Chisholm D J, Furler S M, Campbell L V
Diabetes and Obesity Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Darlinghurst, Australia.
Diabet Med. 2003 Apr;20(4):294-300. doi: 10.1046/j.1464-5491.2003.00938.x.
To examine the relationships between body composition and changes in fasting glycaemia, and in indices of insulin secretion and insulin action over 6 years in females with a family history of Type 2 diabetes with or without prior gestational diabetes ('at risk' group, AR) and control females (control group, C).
At baseline and at follow-up, an oral glucose tolerance test and dual energy X-ray absorptiometry assessment of body composition were performed. Indices of insulin resistance (HOMA R') and insulin secretion (HOMA beta') were obtained from fasting insulin and glucose concentrations.
At baseline, the groups were similar for age, body mass index, fasting levels of plasma glucose and insulin, HOMA R' and HOMA beta'. Despite similar total body fatness, AR had significantly greater waist circumference and central fat (both P < 0.02) compared with C. At follow-up there was a significant increase in central adiposity only in AR, and the fasting plasma glucose (FPG) level was higher in AR compared with C (5.0 +/- 0.2 vs. 4.3 +/- 0.2 mmol/l, P = 0.02). This rise in plasma glucose in AR was related to a decline in HOMA beta' (r = 0.45, P = 0.0065). Both the baseline and the increments in total and central abdominal fat mass were associated with the time-related decline in HOMA beta'.
Six years after initial assessment, AR showed deterioration in FPG levels due predominantly to a decline in insulin secretion index without major change in insulin resistance index. Importantly, baseline body fatness (especially central adiposity), as well as increases in fatness with time, were the major predictors of the subsequent decline of insulin secretion index and the consequent rise in FPG.
研究有或无既往妊娠糖尿病的2型糖尿病家族史女性（“风险”组，AR）和对照女性（对照组，C）的身体成分与空腹血糖变化、胰岛素分泌指标及胰岛素作用指标在6年中的关系。
在基线和随访时，进行口服葡萄糖耐量试验和身体成分的双能X线吸收法评估。从空腹胰岛素和葡萄糖浓度得出胰岛素抵抗指数（HOMA R'）和胰岛素分泌指数（HOMA beta'）。
在基线时，两组在年龄、体重指数、空腹血浆葡萄糖和胰岛素水平、HOMA R'和HOMA beta'方面相似。尽管总体脂肪量相似，但与C组相比，AR组的腰围和中心脂肪显著更大（均P < 0.02）。在随访时，仅AR组的中心肥胖有显著增加，且AR组的空腹血浆葡萄糖（FPG）水平高于C组（5.0±0.2 vs. 4.3±0.2 mmol/l，P = 0.02）。AR组血浆葡萄糖的这种升高与HOMA beta'的下降有关（r = 0.45，P = 0.0065）。基线时以及总体和腹部中心脂肪量的增加均与HOMA beta'随时间的下降有关。
初次评估6年后，AR组FPG水平恶化，主要是由于胰岛素分泌指数下降，而胰岛素抵抗指数无重大变化。重要的是，基线身体脂肪量（尤其是中心肥胖）以及随时间增加的脂肪量是随后胰岛素分泌指数下降及随之而来的FPG升高的主要预测因素。
