Bao Yu-qian, Jia Wei-ping, Chen Lei, Lu Jun-xi, Zhu Min, Lu Wei, Xiang Kun-aan
Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2006 Dec;28(6):740-4.
To study the changes of insulin sensitivity in individuals with impaired glucose tolerance and diabetes and the relationship between insulin sensitivity and over weight/obesity (OW/OB) .
Fifty-two individuals were divided into 4 groups according to WHO diagnostic criteria of obesity (1998) and diabetes (1999): normal weight with normal glucose tolerance (NW-NGT) group, OW/OB with normal glucose tolerance (OW/OB-NGT) group, OW/OB with impaired glucose tolerance (OW/OBIGT) group and OW/OB with diabetes mellitus (OW/OB-DM) group. Individuals in OW/OB-NGT group were further classified into 3 subgroups: over weight subgroup, mild obesity subgroup, and mediate obesity subgroup. Abdominal fat area was measured with magnetic resonance imaging. Visceral obesity was defined as intra-abdominal fat area over 100 cm(2). All subjects with NGT were divided into visceral obesity (VA) group and non-visceral obesity ( Non-VA) group. Extended hyperinsulinemic euglycemic clamp was performed to assess the peripheral tissue insulin sensitivity in all subjects.
The rates of insulin mediated glucose disappearance (Rd) were (3. 25+/-0. 13) mg x kg (-1) min (-1) in OW/OB-NGT group, (3. 06+/-0. 26) mg x kg(-1) x min(-1) in OW/OB-IGT group, and (3.19+/-0.44) mg x kg(-1) x min (-1) in OW/OB-DM group, which were significantly lower than that in NW-NGT group [ (5. 86+/-0. 65) mg x kg (-1) min (-1) ] (P < 0. 05, P < 0.01). The Rd in over weight subgroup [(3.50+/-0. 19) mg kg(-1) x min(-1) ] , mild obesity subgroup [(3. 03+/-0. 13) mg x kg (-1) min(-1)] , and mediate obesity subgroup [(2. 75 +/-0. 24) mg x kg (-1) min(-1)] were significantly lower than that of NW-NGT group (P <0. 05, P <0. 01). The Rd [ (2. 97+/-0. 12) mg kg(-1) x min(-1) vs (4.55+/-0.43) mg x kg(-1) x min(-1)] and glucose oxidation [(1.47 +/-0. 19) mg x kg(-1) min(-1) vs (2.24 +/-0. 19) mg kg(-1) x min(-1) in VA group were significantly decreased than that in non-VA group (P < 0. 05, P < 0. 01). Body mass index, waist and hip ratio, waist circumference, and intra-abdominal fat area were negatively correlated with Rd, respectively (P < 0. 01). Multiple regression analysis showed that body mass index, intra-abdominal fat area and abdominal subcutaneous fat area were the main risk factors of insulin sensitivity.
Insulin sensitivity decreased in OW/OB individuals with or without hyperglycemia. Insulin sensitivity is lower in subjects with visceral obesity. Total body fat and abdominal fat are the main risk factors of insulin sensitivity.
研究糖耐量受损和糖尿病患者胰岛素敏感性的变化，以及胰岛素敏感性与超重/肥胖（OW/OB）之间的关系。
根据世界卫生组织（WHO）1998年肥胖诊断标准和1999年糖尿病诊断标准，将52例个体分为4组：体重正常且糖耐量正常（NW-NGT）组、OW/OB且糖耐量正常（OW/OB-NGT）组、OW/OB且糖耐量受损（OW/OB-IGT）组和OW/OB且患有糖尿病（OW/OB-DM）组。OW/OB-NGT组个体进一步分为3个亚组：超重亚组、轻度肥胖亚组和中度肥胖亚组。采用磁共振成像测量腹部脂肪面积。内脏肥胖定义为腹腔内脂肪面积超过100 cm²。所有糖耐量正常的受试者分为内脏肥胖（VA）组和非内脏肥胖（Non-VA）组。对所有受试者进行延长高胰岛素正常血糖钳夹试验，以评估外周组织胰岛素敏感性。
OW/OB-NGT组胰岛素介导的葡萄糖消失率（Rd）为（3.25±0.13）mg·kg⁻¹·min⁻¹，OW/OB-IGT组为（3.06±0.26）mg·kg⁻¹·min⁻¹，OW/OB-DM组为（3.19±0.44）mg·kg⁻¹·min⁻¹，均显著低于NW-NGT组[（5.86±0.65）mg·kg⁻¹·min⁻¹]（P<0.05，P<0.01）。超重亚组[（3.50±0.19）mg·kg⁻¹·min⁻¹]、轻度肥胖亚组[（3.03±0.13）mg·kg⁻¹·min⁻¹]和中度肥胖亚组[（2.75±0.24）mg·kg⁻¹·min⁻¹]的Rd均显著低于NW-NGT组（P<0.05，P<0.01）。VA组的Rd[（2.97±0.12）mg·kg⁻¹·min⁻¹对（4.55±0.43）mg·kg⁻¹·min⁻¹]和葡萄糖氧化率[（1.47±0.19）mg·kg⁻¹·min⁻¹对（2.24±0.19）mg·kg⁻¹·min⁻¹]均显著低于非VA组（P<0.05，P<0.01）。体重指数、腰臀比、腰围和腹腔内脂肪面积分别与Rd呈负相关（P<0.01）。多元回归分析显示，体重指数、腹腔内脂肪面积和腹部皮下脂肪面积是胰岛素敏感性的主要危险因素。
有或无高血糖的OW/OB个体胰岛素敏感性降低。内脏肥胖患者的胰岛素敏感性较低。全身脂肪和腹部脂肪是胰岛素敏感性的主要危险因素。
