Chan W B, Tong P C Y, Chow C C, So W Y, Ng M C Y, Ma R C W, Osaki R, Cockram C S, Chan J C N
Department of Medicine and Therapeutics, The Chinese University of Hong Kong and The Diabetes Mellitus and Endocrine Centre, The Prince of Wales Hospital, Shatin, Hong Kong.
Diabet Med. 2004 Apr;21(4):349-53. doi: 10.1111/j.1464-5491.2004.01158.x.
Chinese Type 2 diabetic subjects are generally less obese than their Caucasian counterparts. We hypothesized that lean and obese Chinese Type 2 diabetic subjects have different metabolic and insulin secretory profiles. We compared the clinical features, C peptide and metabolic status between lean/normal weight and obese diabetic subjects.
We conducted a cross-sectional study on 521 consecutive diabetic subjects newly referred to a Diabetes Clinic in 1996. The subjects were categorized into underweight (< 18.5 kg/m(2)), normal weight (18.5-23 kg/m(2)) and overweight (>/= 23 kg/m(2)) according to the re-defined WHO criterion for obesity in Asia Pacific Region. Metabolic and anthropometric parameters were compared between groups with different levels of obesity.
In this cohort, 5.8, 30.6 and 63.7% of subjects were underweight, normal weight and overweight, respectively, using the 'Asian' criteria. Of these 521 subjects, 20% had fasting C-peptide less than 0.2 nmol/l, suggesting insulin deficiency. Fasting C-peptide showed linear increasing trend (P < 0.001) while HbA(1c) showed decreasing trend (P = 0.001) with BMI after adjustment for duration of disease. There were more subjects in the underweight group who were treated with insulin (41.3% vs. 13.9 and 8.2%, P < 0.001). Although homeostasis model assessment was similar amongst the three groups, systolic (P = 0.006) and diastolic blood pressure (P < 0.001) and triglyceride (P < 0.001) showed increasing, while HDL-C (P < 0.001) showed decreasing, trends across different BMI groups. The underweight patients had the lowest C-peptide and highest HbA(1c) while overweight patients had the highest C-peptide, blood pressure, triglyceride but lowest HbA(1c) levels.
In Chinese Type 2 diabetic patients, lean subjects had predominant insulin deficiency and obese subjects had features of metabolic syndrome. Clinicians should have low threshold to initiate insulin therapy in lean Type 2 diabetic patients with suboptimal glycaemic control. In obese diabetic patients, aggressive control of multiple cardiovascular risks is of particular importance.
中国2型糖尿病患者通常比白种人同行肥胖程度更低。我们推测瘦型和肥胖型中国2型糖尿病患者具有不同的代谢和胰岛素分泌特征。我们比较了瘦/正常体重和肥胖糖尿病患者之间的临床特征、C肽和代谢状况。
我们对1996年新转诊至一家糖尿病诊所的521例连续糖尿病患者进行了横断面研究。根据亚太地区重新定义的WHO肥胖标准，将受试者分为体重过轻（<18.5 kg/m²）、正常体重（18.5 - 23 kg/m²）和超重（≥23 kg/m²）。比较了不同肥胖水平组之间的代谢和人体测量参数。
在该队列中，按照“亚洲”标准，分别有5.8%、30.6%和63.7%的受试者体重过轻、正常体重和超重。在这521例受试者中，20%的患者空腹C肽低于0.2 nmol/l，提示胰岛素缺乏。校正病程后，空腹C肽随BMI呈线性上升趋势（P < 0.001），而糖化血红蛋白（HbA1c）呈下降趋势（P = 0.001）。体重过轻组中接受胰岛素治疗的患者更多（41.3%对13.9%和8.2%，P < 0.001）。尽管三组之间稳态模型评估相似，但收缩压（P = 0.006）、舒张压（P < 0.001）和甘油三酯（P < 0.001）在不同BMI组中呈上升趋势，而高密度脂蛋白胆固醇（HDL-C，P < 0.001）呈下降趋势。体重过轻的患者C肽最低、HbA1c最高，而超重患者C肽、血压、甘油三酯最高，但HbA1c水平最低。
在中国2型糖尿病患者中，瘦型患者以胰岛素缺乏为主，肥胖患者具有代谢综合征特征。对于血糖控制欠佳的瘦型2型糖尿病患者，临床医生应降低启动胰岛素治疗的阈值。对于肥胖糖尿病患者，积极控制多种心血管风险尤为重要。
