Pontiroli A E, Pizzocri P, Caumo A, Perseghin G, Luzi L
Dipartimento di Medicina Interna, Ospedale San Paolo, Università di Milano, Via A. Di Rudini 8, I-20142, Milan, Italy.
Acta Diabetol. 2004 Jun;41(2):70-6. doi: 10.1007/s00592-004-0147-x.
We evaluated both insulin release (IR) and insulin sensitivity (IS) through a single oral glucose tolerance test (OGTT) (blood samples at 0, 60, 120 min, as routinely performed in Europe) in subjects with normal and abnormal glucose tolerance. The value 1/HOMA was used as an index of IS and deltaI/deltaG at 60 min was used as an index of IR. In preliminary experiments, 1/HOMA correlated with glucose infusion rate (GIR) at euglycaemic insulin clamp (r=0.495) and with insulin sensitivity index (ISI) at LDIGIT (r=0.714). At OGTT with blood samples at 0, 30, 60 and 120 min, insulin levels at 30 min correlated with insulin levels at 60 min (I30 vs. I60, r=0.584) and deltaI/deltaG at 30 and at 60 min correlated (r=0.365). Values of 1/HOMA from 345 subjects with normal glucose tolerance (NGT), 32 with impaired fasting glucose (IFG), 186 with impaired glucose tolerance (IGT) and 72 with type 2 diabetic mellitus were divided into quartiles. For each quartile, mean (+/- SE) and 95% confidence intervals (CI) of deltaI/deltaG at 60 min were calculated, and subjects were represented by plotting IS vs. IR. Plots of NGT, IGT, and type-2 diabetes mellitus described different curves. Values of subjects with IFG, IGT and type 2 diabetes mellitus fell outside the 95% CI of NGT subjects in all quartiles of IS. To validate this finding, 113 morbidly obese subjects (basal OGTT: 55 NGT, 40 IGT, 18 T2DM) who underwent a major reduction of body weight through bariatric surgery received a second OGTT one year after surgery. Glucose tolerance improved in 40 patients, deteriorated in 8, did not change in 65; the new plots were concordant with the new class of glucose tolerance. OGTT can be used to evaluate both IR and IS in subjects with NGT, IFG, IGT, and type 2 diabetes mellitus in population studies and in follow-up studies. IFG, IGT and type 2 diabetes mellitus are characterized by reduced IR compared to IS.
我们通过单次口服葡萄糖耐量试验（OGTT）（在0、60、120分钟采集血样，这是欧洲常规操作）对糖耐量正常和异常的受试者进行胰岛素释放（IR）和胰岛素敏感性（IS）评估。1/HOMA值用作IS指标，60分钟时的deltaI/deltaG用作IR指标。在初步实验中，1/HOMA与正常血糖胰岛素钳夹时的葡萄糖输注速率（GIR）相关（r = 0.495），与LDIGIT时的胰岛素敏感性指数（ISI）相关（r = 0.714）。在0、30、60和120分钟采集血样的OGTT中，30分钟时的胰岛素水平与60分钟时的胰岛素水平相关（I30与I60，r = 0.584），30分钟和60分钟时的deltaI/deltaG相关（r = 0.365）。将345例糖耐量正常（NGT）受试者、32例空腹血糖受损（IFG）受试者、186例糖耐量受损（IGT）受试者和72例2型糖尿病患者的1/HOMA值分为四分位数。对于每个四分位数，计算60分钟时deltaI/deltaG的均值（±SE）和95%置信区间（CI），并通过绘制IS与IR的关系图来展示受试者情况。NGT、IGT和2型糖尿病的关系图呈现出不同曲线。在IS的所有四分位数中，IFG、IGT和2型糖尿病患者的值均落在NGT受试者的95%CI之外。为验证这一发现，113例通过减肥手术大幅减轻体重的病态肥胖受试者（基础OGTT：55例NGT、40例IGT、18例T2DM）在术后一年接受了第二次OGTT。40例患者糖耐量改善，8例恶化，65例无变化；新的关系图与新的糖耐量类别一致。在人群研究和随访研究中，OGTT可用于评估NGT、IFG、IGT和2型糖尿病患者的IR和IS。与IS相比，IFG、IGT和2型糖尿病的特征是IR降低。
