Klein David J, Aronson Friedman Lisa, Harlan William R, Barton Bruce A, Schreiber George B, Cohen Robert M, Harlan Linda C, Morrison John A
Division of Endocrinology and Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Diabetes Care. 2004 Feb;27(2):378-83. doi: 10.2337/diacare.27.2.378.
Age at onset of type 2 diabetes has decreased during the past 20 years, especially in black women. Studies of factors associated with insulin resistance and hyperglycemia in preadolescent and adolescent populations are essential to understanding diabetes development.
The National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study (NGHS) is a 10-year cohort study of the development of obesity in black and white girls. Two NGHS centers examined the associations of obesity, puberty, and race with fasting insulin, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR; a calculated index of insulin resistance) measures at 9-10 years of age (baseline) and 10 years later.
Black girls had greater baseline and year-10 BMI than white girls, with a greater 10-year incidence of obesity. BMI-insulin correlations were positive in both black and white girls at both visits, but insulin remained higher in black girls after controlling for BMI. In black girls, insulin and HOMA-IR were higher in the prepubertal period (before the emergence of racial differences in BMI), increased more during puberty, and decreased less with its completion. Baseline BMI predicted year-10 glucose and the development of impaired fasting glucose (IFG) in black girls. In white girls, the rate of BMI increase during follow-up predicted these outcomes. The 10-year incidence of diabetes in black girls was 1.4%.
Black-white differences in insulin resistance are not just a consequence of obesity, but precede the pubertal divergence in BMI. The development of IFG appears to be a function of the rate of increase of BMI in white girls and early obesity in black girls.
在过去20年中，2型糖尿病的发病年龄有所下降，尤其是在黑人女性中。研究青春期前和青春期人群中与胰岛素抵抗和高血糖相关的因素对于理解糖尿病的发展至关重要。
美国国立心肺血液研究所（NHLBI）的生长与健康研究（NGHS）是一项针对黑人和白人女孩肥胖症发展的为期10年的队列研究。两个NGHS中心研究了肥胖、青春期和种族与9至10岁（基线）及10年后空腹胰岛素、血糖和胰岛素抵抗稳态模型评估（HOMA-IR；一种计算得出的胰岛素抵抗指数）指标之间的关联。
黑人女孩在基线和第10年时的BMI均高于白人女孩，肥胖的10年发病率更高。在两次访视中，黑人和白人女孩的BMI与胰岛素的相关性均为正，但在控制BMI后，黑人女孩的胰岛素水平仍然更高。在黑人女孩中，胰岛素和HOMA-IR在青春期前（BMI出现种族差异之前）较高，在青春期增加更多，在青春期结束时下降较少。基线BMI可预测黑人女孩第10年的血糖水平以及空腹血糖受损（IFG）的发展。在白人女孩中，随访期间BMI的增加速率可预测这些结果。黑人女孩的糖尿病10年发病率为1.4%。
胰岛素抵抗的黑白差异不仅仅是肥胖的结果，而是先于BMI的青春期差异出现。IFG的发展似乎是白人女孩BMI增加速率和黑人女孩早期肥胖的函数。
