[不同体重指数的新诊断2型糖尿病患者胰岛素分泌及胰岛素抵抗特征]

[Features of insulin secretion and insulin resistance in newly diagnosed type 2 diabetes of different body mass indices].

作者信息

An Ya-Li, Gao Yan, Zhu Qian, Ning Guang, Jia Wei-Ping, Huang Qin, Xu Wen, Li Cheng-Jiang, Zhou Zhi-Guang, Shi Bing-Yin, Shan Zhong-Yan, Chen Lu-Lu, Xu Zhang-Rong, Wang Heng, Yan Li, Zhong Hui-Ju, Ji Qiu-He, Li Hong, Xue Yuan-Ming, Zhing Mu-Xun, Gu Wei, Guo Xiao-Hui, Gao Lei-Li, Hong Jie, Liu Fang, Zou Da-Jin, Li Yan-Bing, Zhang Xiao-Ying, Li Zhen, Guo Gui, Zhao Xiao-Juan, Wu Han-Ni, Wang Yu-Zhen, Zhao Wei-Gang, Zhang Shao-Lin, Wu Jing, Zhang Nan-Yan, Yang Feng-Ying, Zhang Yun, Zhou Xin-Rong, Ren Yue-Zhong, Li Guang-Wei

机构信息

Center for Endocrine and Metabolic Diseases, China-Japan friendship hospital, Peking Union Medical College, Beijing 100029, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Apr 28;89(16):1117-21.

PMID:19595144

Abstract

OBJECTIVE

To investigate insulin secretion function and insulin resistance in Chinese newly diagnosed type 2 diabetes (obese and non-obese patients) in order to provide evidence for clinical treatment.

METHODS

408 newly diagnosed type 2 diabetes and 40 normal controls were recruited. Height, weight were measured, insulin and glucose of 0 min, 30 min, 60 min, 120 min during oral glucose tolerance test were examined. The patients with fasting glucose level greater than 8.3mmol/L were treatment with Gliclazide for 1 - 3 months. After normalization of the plasma glucose levels for more than 2 weeks, and withdraw this medication for 48 hours, then OGTT were repeated to assess IR and IS.

RESULTS

The patients were divided into four groups based on fasting plasma glucose (DM1: FPG < 6.9mmol/L; DM2: 6.9 mmol/L < or = FPG < 8.3 mmol/L; DM3: 8.3 mmol/L < or = FPG < 9.7 mmol/L; DM4: FPG > or = 9.7 mmol/L). Every groups were further stratified to subgroups by cut point of BMI = 24 kg/m(2). Their insulin sensitivity and insulin secretion function compared between subgroups. (1) True insulin level in BMI > or = 24 (FPG < 6.9 mmol/L) subgroups were higher than control's (3.5 +/- 0.5 vs 3.2 +/- 0.6 natural logarithm) (P < 0.05). (2) In BMI > or = 24 subgroups, their insulin sensitivity were even worse than BMI < 24 groups', but their insulin secretion function were better at the same FPG level. (3) After intervention, the change of insulin sensitivity in BMI < 24 group was better than BMI > or = 24 group's (-4.7 +/- 0.9 vs -5.5 +/- 1.4 natural logarithm) (P < 0.05); but the change of insulin secretion function in BMI < 24 group was worse.

CONCLUSION

(1) In newly diagnostic type 2 diabetes, insulin sensitivity and insulin secretion function were decreased with the increase of FPG, but they were different between obese and non-obese group. (2) Insulin secretion function was recovered better in obese group when eliminated glucose toxicity.

摘要

目的

研究中国新诊断2型糖尿病患者（肥胖和非肥胖）的胰岛素分泌功能及胰岛素抵抗，为临床治疗提供依据。

方法

招募408例新诊断2型糖尿病患者及40例正常对照者。测量身高、体重，检测口服葡萄糖耐量试验0分钟、30分钟、60分钟、120分钟时的胰岛素及血糖。空腹血糖水平大于8.3mmol/L的患者使用格列齐特治疗1 - 3个月。待血糖水平正常2周以上，停药48小时后重复口服葡萄糖耐量试验以评估胰岛素抵抗（IR）和胰岛素分泌（IS）。

结果

根据空腹血糖将患者分为四组（DM1：空腹血糖＜6.9mmol/L；DM2：6.9mmol/L≤空腹血糖＜8.3mmol/L；DM3：8.3mmol/L≤空腹血糖＜9.7mmol/L；DM4：空腹血糖≥9.7mmol/L）。每组再按体重指数（BMI）=24kg/m²切点进一步分层为亚组，比较各亚组间胰岛素敏感性及胰岛素分泌功能。（1）BMI≥24（空腹血糖＜6.9mmol/L）亚组的真胰岛素水平高于对照组（3.5±0.5对3.2±0.6自然对数）（P＜0.05）。（2）在BMI≥24亚组中，相同空腹血糖水平下其胰岛素敏感性比BMI＜24组更差，但胰岛素分泌功能更好。（3）干预后，BMI＜24组胰岛素敏感性变化优于BMI≥24组（-4.7±0.9对-5.5±1.4自然对数）（P＜0.05）；但BMI＜24组胰岛素分泌功能变化更差。