McClain D A, Abraham D, Rogers J, Brady R, Gault P, Ajioka R, Kushner J P
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
Diabetologia. 2006 Jul;49(7):1661-9. doi: 10.1007/s00125-006-0200-0. Epub 2006 Mar 15.
AIMS/HYPOTHESIS: The prevalence and mechanisms of diabetes in hereditary haemochromatosis are not known. We therefore measured glucose tolerance, insulin secretory capacity and insulin sensitivity in adults with haemochromatosis.
Subjects recruited from referrals to a haemochromatosis clinic underwent OGTT and frequently sampled IVGTT. A chart review of former clinic patients was also performed.
The prevalence of diabetes (23%) and IGT (30%) was increased in haemochromatosis compared with matched control subjects (0% diabetes and 14% IGT). Subjects with haemochromatosis and diabetes were overweight (14%) or obese (86%). The prevalence of diabetes, as determined by chart review of fasting glucose values, in subjects who had haemochromatosis and were in the 40-79 years age range was 26%. Overall, patients with haemochromatosis and control subjects had similar values for acute insulin response to glucose and insulin sensitivity. However, patients with haemochromatosis and IGT had a 68% decrease in acute insulin response to glucose (p<0.02) compared with those with NGT. They were not insulin-resistant, exhibiting instead a 62% increase in insulin sensitivity (NS). Haemochromatosis subjects with diabetes exhibited further declines in acute insulin response to glucose, insulin resistance, or both.
CONCLUSIONS/INTERPRETATION: Diabetes and IGT are common in haemochromatosis, justifying screening for diabetes and therapeutic phlebotomy. The major abnormality associated with IGT is decreased insulin secretory capacity. Diabetes is usually associated with obesity and concomitant insulin resistance.
目的/假设：遗传性血色素沉着症中糖尿病的患病率及发病机制尚不清楚。因此，我们对患有血色素沉着症的成年人进行了葡萄糖耐量、胰岛素分泌能力和胰岛素敏感性的检测。
从血色素沉着症诊所转诊的患者接受了口服葡萄糖耐量试验（OGTT）和频繁采样的静脉葡萄糖耐量试验（IVGTT）。同时对之前诊所患者的病历进行了回顾。
与匹配的对照受试者（糖尿病患病率0%，糖耐量受损患病率14%）相比，血色素沉着症患者中糖尿病（23%）和糖耐量受损（30%）的患病率有所升高。患有血色素沉着症和糖尿病的受试者超重（14%）或肥胖（86%）。通过对空腹血糖值的病历回顾确定，年龄在40 - 79岁的血色素沉着症患者中糖尿病患病率为26%。总体而言，血色素沉着症患者和对照受试者对葡萄糖的急性胰岛素反应及胰岛素敏感性值相似。然而，与糖耐量正常者相比，患有血色素沉着症和糖耐量受损的患者对葡萄糖的急性胰岛素反应降低了68%（p<0.02）。他们并非胰岛素抵抗，相反，胰岛素敏感性增加了62%（无统计学意义）。患有糖尿病的血色素沉着症受试者对葡萄糖的急性胰岛素反应、胰岛素抵抗或两者均进一步下降。
结论/解读：糖尿病和糖耐量受损在血色素沉着症中很常见，这为糖尿病筛查和治疗性放血提供了依据。与糖耐量受损相关的主要异常是胰岛素分泌能力下降。糖尿病通常与肥胖及伴随的胰岛素抵抗有关。
