Department of Medicine, BMA Medical College and Vajira Hospital, Bangkok, Thailand.
Metab Syndr Relat Disord. 2010 Apr;8(2):113-8. doi: 10.1089/met.2009.0030.
The aim of this study was to investigate insulin sensitivity and secretion in lean and obese Asian (Thai) type 2 diabetic patients.
Insulin sensitivity and insulin secretion was assessed with the hyperinsulinemic euglycemic (80 mU/m(2) per min) and hyperglycemic clamp technique in 9 lean and 10 obese patients with type 2 diabetes and 4 lean and 4 obese nondiabetic control subjects.
Obese type 2 diabetics had a lower M-value (sensitivity to exogenous insulin) than lean type 2 diabetics (8.7 +/- 1.3 versus 16.5 +/- 1.6 mg . fat free mass kg(-1) . min(-1), P < 0.001) and obese control subjects (15.9 +/- 4.0 mg . fat free mass kg(-1) . min(-1), P < 0.05). Insulin sensitivity (M-value) was similar in lean type 2 diabetics as compared to lean nondiabetic control subjects. During the hyperglycemic clamp, the first (P < 0.001) and second phase (P < 0.02) of insulin and C-peptide response (P < 0.02) was significantly decreased in lean type 2 diabetics as compared to lean nondiabetic subjects. In obese type 2 diabetics, the first and second phase of insulin response was significantly decreased (P < 0.05) compared to obese nondiabetic subjects.
Obese type 2 diabetics have significant defects in both insulin sensitivity and insulin secretion whereas lean type 2 diabetics demonstrate primarily a defect in insulin secretion. Lean diabetics have similar insulin sensitivity when compared to healthy age- and sex-matched nondiabetic subjects during the euglycemic clamp study, suggesting the lack of significant insulin resistance in lean type 2 diabetics.
本研究旨在探讨瘦型和肥胖型亚洲（泰国）2 型糖尿病患者的胰岛素敏感性和胰岛素分泌情况。
采用高胰岛素正葡萄糖（80mU/m2·min）钳夹技术检测 9 例瘦型和 10 例肥胖型 2 型糖尿病患者及 4 例瘦型和 4 例肥胖型非糖尿病对照者的胰岛素敏感性和胰岛素分泌功能。
肥胖 2 型糖尿病患者的 M 值（对外源胰岛素的敏感性）较瘦型 2 型糖尿病患者（8.7±1.3 比 16.5±1.6mg·kgFFM-1·min-1，P<0.001）和肥胖对照组（15.9±4.0mg·kgFFM-1·min-1，P<0.05）低。瘦型 2 型糖尿病患者的胰岛素敏感性（M 值）与瘦型非糖尿病对照组相似。在高血糖钳夹试验中，瘦型 2 型糖尿病患者的胰岛素和 C 肽第一时相（P<0.001）和第二时相（P<0.02）及 C 肽第二时相（P<0.02）反应均显著低于瘦型非糖尿病对照组。肥胖 2 型糖尿病患者的胰岛素第一时相和第二时相反应均显著低于肥胖非糖尿病对照组（P<0.05）。
肥胖 2 型糖尿病患者存在胰岛素敏感性和胰岛素分泌的双重缺陷，而瘦型 2 型糖尿病患者则主要表现为胰岛素分泌缺陷。与健康的年龄和性别匹配的非糖尿病对照组相比，在正葡萄糖钳夹试验中，瘦型 2 型糖尿病患者的胰岛素敏感性相似，提示瘦型 2 型糖尿病患者中不存在显著的胰岛素抵抗。
