García-Fuentes Eduardo, García-Almeida Jose Manuel, García-Arnés Juan, Rivas-Marín Jose, Gallego-Perales Jose Luis, González-Jiménez Belén, Cardona Isabel, García-Serrano Sara, Garriga M José, Gonzalo Montserrat, de Adana M Sol Ruiz, Soriguer Federico
Fundación IMABIS, Málaga, Spain.
Obes Surg. 2006 Sep;16(9):1179-88. doi: 10.1381/096089206778392383.
Obesity is often associated with hyper-secrection of insulin. Impaired fasting glucose (IFG) has recently been redefined as a fasting plasma glucose of 5.6-6.9 mmol/L. The aim of this study was to determine whether changes in insulin secretion in morbidly obese persons also commence with normal serum glucose levels.
32 morbidly obese subjects were studied before and after bariatric surgery. Measurements were made of glucose tolerance (K(G)), insulin sensitivity (SI), first-phase insulin release and the disposition index (DI) from a frequently sampled intravenous glucose tolerance test.
In morbidly obese subjects, the SI (P<0.01), DI (P<0.01) and first-phase insulin release (P<0.02) started changing with serum glucose levels considered to be normal (5.00-5.28 mmol/L). K(G) showed a clear slope according to the baseline glycemia status (P<0.05), and it was significantly related with the DI, both before (r=0.76, P<0.001) and after (r=0.57, P=0.002) surgery. Following surgery, all the variables significantly associated with insulin secretion and insulin sensitivity recovered significantly. The most significant changes occurred in morbidly obese individuals with IFG.
Morbidly obese subjects show slopes of insulin sensitivity and insulin secretion in accordance with their baseline serum glucose levels. The fall in first-phase insulin release begins when serum glucose values are considered normal. Morbidly obese persons with the IFG phenotype have a specific pattern of insulin sensitivity and insulin secretion. K(G) clearly discriminates the clinical phenotypes, depending on baseline serum glucose levels.
肥胖常与胰岛素分泌过多有关。空腹血糖受损（IFG）最近被重新定义为空腹血糖水平为5.6 - 6.9 mmol/L。本研究的目的是确定病态肥胖者胰岛素分泌的变化是否也始于正常血糖水平。
对32例病态肥胖受试者在减肥手术前后进行研究。通过频繁采样静脉葡萄糖耐量试验测量葡萄糖耐量（K(G)）、胰岛素敏感性（SI）、第一相胰岛素释放和处置指数（DI）。
在病态肥胖受试者中，SI（P<0.01）、DI（P<0.01）和第一相胰岛素释放（P<0.02）在被认为是正常的血糖水平（5.00 - 5.28 mmol/L）时就开始发生变化。K(G)根据基线血糖状态呈现明显斜率（P<0.05），并且在手术前（r = 0.76，P<0.001）和手术后（r = 0.57，P = 0.002）均与DI显著相关。手术后，所有与胰岛素分泌和胰岛素敏感性显著相关的变量均显著恢复。最显著的变化发生在患有IFG的病态肥胖个体中。
病态肥胖受试者的胰岛素敏感性和胰岛素分泌斜率与其基线血糖水平一致。当血糖值被认为正常时，第一相胰岛素释放就开始下降。具有IFG表型的病态肥胖者具有特定的胰岛素敏感性和胰岛素分泌模式。K(G)根据基线血糖水平能清晰地区分临床表型。
