Park Seok Won, Kim Soo Kyung, Cho Yong-Wook, Kim Dae Jung, Song Young-Duk, Choi Young Ju, Huh Byung Wook, Choi Sung Hee, Jee Sun Ha, Cho Mi Ae, Lee Eun Jig, Huh Kap Bum
Department of Internal Medicine, Pochon CHA University, Sungnam, Republic of Korea.
Atherosclerosis. 2009 Jul;205(1):309-13. doi: 10.1016/j.atherosclerosis.2008.12.006. Epub 2008 Dec 13.
Insulin resistance may provide a crucial link between type 2 diabetes and cardiovascular disease. However, it is still unclear whether insulin resistance itself or hyperinsulinemia is independently associated with subclinical atherosclerosis. We hypothesized that insulin resistance, but not hyperinsulinemia, would be associated with carotid atherosclerosis in patients with type 2 diabetes.
We examined 2471 patients with type 2 diabetes, consecutively enrolled in Huh Diabetes Center. Insulin sensitivity was directly assessed by a rate constant for plasma glucose disappearance (Kitt) using short insulin tolerance test. Fasting insulin levels were used as a marker of hyperinsulinemia. Both carotid arteries were examined by B-mode ultrasound. Carotid atherosclerosis was defined by having a clearly isolated focal plaque or mean carotid intima-media thickness (IMT) >or=1.1mm.
In multiple regression models, insulin sensitivity index (Kitt) but not hyperinsulinemia was significantly associated with carotid IMT adjusting for known risk factors such as age, sex, BMI, smoking, systolic pressure, HDL and LDL cholesterol. One standard deviation decrease in Kitt was associated with 0.046 mm increase in carotid IMT (p=0.015). Furthermore, odds ratio for carotid atherosclerosis was 1.43 (95% CI: 1.10, 1.86) in type 2 diabetic patients with insulin resistance (lowest quartile of insulin sensitivity) adjusting for known risk factors. The results were consistent in all subgroups stratified by sex, age, smoking and hypertension.
Insulin resistance measured by short insulin tolerance test, but not hyperinsulinemia, is independently associated with carotid atherosclerosis in patients with type 2 diabetes.
胰岛素抵抗可能是2型糖尿病与心血管疾病之间的关键联系。然而，胰岛素抵抗本身或高胰岛素血症是否独立与亚临床动脉粥样硬化相关仍不清楚。我们假设胰岛素抵抗而非高胰岛素血症与2型糖尿病患者的颈动脉粥样硬化有关。
我们检查了连续入选呼市糖尿病中心的2471例2型糖尿病患者。使用短胰岛素耐量试验通过血浆葡萄糖消失速率常数（Kitt）直接评估胰岛素敏感性。空腹胰岛素水平用作高胰岛素血症的标志物。通过B型超声检查双侧颈动脉。颈动脉粥样硬化定义为有明确孤立的局灶性斑块或平均颈动脉内膜中层厚度（IMT）≥1.1mm。
在多元回归模型中，调整年龄、性别、BMI、吸烟、收缩压、高密度脂蛋白和低密度脂蛋白胆固醇等已知危险因素后，胰岛素敏感性指数（Kitt）而非高胰岛素血症与颈动脉IMT显著相关。Kitt每降低一个标准差，颈动脉IMT增加0.046mm（p = 0.015）。此外，在调整已知危险因素的情况下，胰岛素抵抗（胰岛素敏感性最低四分位数）的2型糖尿病患者发生颈动脉粥样硬化的优势比为1.43（95%可信区间：1.10，1.86）。在按性别、年龄、吸烟和高血压分层的所有亚组中结果均一致。
通过短胰岛素耐量试验测得的胰岛素抵抗而非高胰岛素血症与2型糖尿病患者的颈动脉粥样硬化独立相关。
