Monnier L, Colette C, Thuan J-F, Lapinski H
Department of Metabolic Diseases, Lapeyronie Hospital, University Institute of Clinical Research, Montpellier, France.
Eur J Clin Invest. 2006 Apr;36(4):231-5. doi: 10.1111/j.1365-2362.2006.01623.x.
Defects in insulin secretion and sensitivity, two major determinants of glycaemic control, can occur and progress or not in parallel. The present study was designed to compare the respective roles of both determinants on HbA1c, in type 2 diabetic patients, according to whether or not residual beta-cell function was stimulated with insulin secretagogues.
Insulin secretion and insulin sensitivity were both estimated using the homeostasis model assessment (HOMA). HbA1c, insulin sensitivity (HOMA2%S) and insulin secretion (HOMA2%B) were determined in 289 noninsulin-using type 2 diabetic patients who were further divided into two groups according to treatment: metformin alone (group I, n = 57) or metformin and glyburide (group II, n = 232). The patients of both groups were further divided into three subsets in order to test the dependence of HbA1c on HOMA2%B and HOMA2%S.
In group I mean HbA1c were greater (8.4%) in patients with HOMA2%B < 50% than in the two subsets with HOMA2%B > or = 50%: 7.2 and 6.8% (P = 0.0013). In group II mean values of stimulated-insulin secretion (HOMA2%B) were lesser (40.7 and 30.1%) in the two subsets of patients with HbA1c > or = 8% than in patients with HbA1c < 8%: 55.1% (P < 0.0001). By contrast, we found no differences in both groups with HOMA2%S. A stepwise multiple regression showed that HOMA2%B contributed to HbA1c more than HOMA2%S both in groups I (33.5% vs. 23.4%) and II (22.7% vs. 8%).
Although the role of insulin sensitivity is not negligible, insulin secretion appears to be the major determinant of diabetic control in overt type 2 diabetic patients who are treated with metformin alone or with a two-drug therapy combining metformin and glyburide.
胰岛素分泌和敏感性缺陷是血糖控制的两个主要决定因素，它们可能并行出现、进展或不进展。本研究旨在根据胰岛素促分泌剂是否刺激残余β细胞功能，比较这两个决定因素在2型糖尿病患者中对糖化血红蛋白（HbA1c）的各自作用。
胰岛素分泌和胰岛素敏感性均采用稳态模型评估（HOMA）进行估算。对289例未使用胰岛素的2型糖尿病患者测定HbA1c、胰岛素敏感性（HOMA2%S）和胰岛素分泌（HOMA2%B），并根据治疗方法将患者进一步分为两组：单独使用二甲双胍（I组，n = 57）或二甲双胍与格列本脲联合使用（II组，n = 232）。两组患者再进一步分为三个亚组，以测试HbA1c对HOMA2%B和HOMA2%S的依赖性。
在I组中，HOMA2%B < 50%的患者平均HbA1c水平（8.4%）高于HOMA2%B≥50%的两个亚组：分别为7.2%和6.8%（P = 0.0013）。在II组中，HbA1c≥8%的两个亚组患者的刺激后胰岛素分泌（HOMA2%B）平均值（40.7%和30.1%）低于HbA1c < 8%的患者：为55.1%（P < 0.0001）。相比之下，两组患者的HOMA2%S无差异。逐步多元回归显示，在I组（33.5%对23.4%）和II组（22.7%对8%）中，HOMA2%B对HbA1c的影响均大于HOMA2%S。
尽管胰岛素敏感性的作用不可忽视，但在单独使用二甲双胍或二甲双胍与格列本脲联合使用的两药治疗方案治疗的显性2型糖尿病患者中，胰岛素分泌似乎是糖尿病控制的主要决定因素。
