Chaiken R L, Banerji M A, Pasmantier R, Huey H, Hirsch S, Lebovitz H E
Department of Medicine, State University of New York, Brooklyn 11203.
Diabetes Care. 1991 Nov;14(11):1036-42. doi: 10.2337/diacare.14.11.1036.
We had previously shown two variants among black non-insulin-dependent diabetic (NIDDM) subjects in a normoglycemic remission: one with insulin resistance and the other with normal insulin sensitivity. This study examined whether these two variants exist in the ordinary hyperglycemic black NIDDM population.
Fifty-two black NIDDM subjects were assessed for insulin-stimulated glucose disposal (euglycemic clamp), glycemic control (fasting plasma glucose and HbA1c), and fasting lipid profiles.
The distribution of glucose disposal in 30 black NIDDM subjects (body mass index; BMI less than 30 kg/m2) was bimodal, which indicated two populations. Eighteen of 30 subjects (BMI 26.4 +/- 0.5 kg/m2) had insulin resistance (glucose disposal 3.21 +/- 0.24 mg.kg-1.min-1). Twelve of 30 subjects (BMI 24.83 +/- 1.1 kg/m2) had normal insulin sensitivity (glucose disposal 7.19 +/- 0.46 mg.kg-1.min-1). Twenty-one of the remaining 22 subjects (BMI 33.4 +/- 0.7 kg/m2) were insulin resistant (glucose disposal 2.88 +/- 0.21 mg.kg-1.min-1). Fasting serum triglyceride levels were lowest in the insulin-sensitive population (0.91 +/- 0.07 mM) and different from the insulin-resistant population, BMI less than 30 and greater than 30 kg/m2, (1.20 +/- 0.10 mM, P less than 0.05 and 1.42 +/- 0.17 mM, P less than 0.025, respectively). Fasting serum low-density lipoprotein cholesterol levels were not significantly different among the groups, although it did increase with insulin resistance and increasing obesity. Total serum cholesterol levels and glycemic control were similar for all three groups. Serum high-density lipoprotein cholesterol levels were higher in women compared with men.
In the hyperglycemic black NIDDM population, two variants exist: one with insulin resistance and one with normal insulin sensitivity. This insulin-sensitive variant represents 40% of subjects with a BMI less than 30 kg/m2. Moreover, the insulin-sensitive group has a lower risk profile for cardiovascular disease.
我们之前已经在血糖正常缓解的黑人非胰岛素依赖型糖尿病（NIDDM）患者中发现了两种变体：一种存在胰岛素抵抗，另一种胰岛素敏感性正常。本研究调查了这两种变体在普通高血糖黑人NIDDM人群中是否存在。
对52名黑人NIDDM患者进行了胰岛素刺激的葡萄糖处置评估（正常血糖钳夹法）、血糖控制情况（空腹血糖和糖化血红蛋白）以及空腹血脂水平检测。
30名黑人NIDDM患者（体重指数；BMI小于30kg/m2）的葡萄糖处置分布呈双峰模式，这表明存在两个群体。30名患者中有18名（BMI 26.4±0.5kg/m2）存在胰岛素抵抗（葡萄糖处置率为3.21±0.24mg·kg-1·min-1）。30名患者中有12名（BMI 24.83±1.1kg/m2）胰岛素敏感性正常（葡萄糖处置率为7.19±0.46mg·kg-1·min-1）。其余22名患者中有21名（BMI 33.4±0.7kg/m2）存在胰岛素抵抗（葡萄糖处置率为2.88±0.21mg·kg-1·min-1）。胰岛素敏感人群的空腹血清甘油三酯水平最低（0.91±0.07mM），与胰岛素抵抗人群不同，BMI小于30和大于30kg/m2的胰岛素抵抗人群的空腹血清甘油三酯水平分别为（1.20±0.10mM，P<0.05和1.42±0.17mM，P<0.025）。尽管空腹血清低密度脂蛋白胆固醇水平确实随胰岛素抵抗和肥胖程度增加而升高，但各组之间差异无统计学意义。三组患者的总血清胆固醇水平和血糖控制情况相似。女性的血清高密度脂蛋白胆固醇水平高于男性。
在高血糖黑人NIDDM人群中存在两种变体：一种存在胰岛素抵抗，另一种胰岛素敏感性正常。这种胰岛素敏感变体占BMI小于30kg/m2患者的40%。此外，胰岛素敏感组患心血管疾病的风险较低。
