糖耐量正常-高胰岛素血症个体转化为2型糖尿病的临床特征及趋势

[The clinical characteristics and trend of conversion to type 2 diabetes mellitus of individuals with normal glucose tolerance-hyperinsulinemia].

作者信息

Fang Fu-sheng, Tian Hui, Li Chun-lin, Shao Ying-hong, Li Jian, Zhong Wen-wen, Liu Min-yan, Yan Shuang-tong, Yang Guang, Cheng Xiao-ling, Ma Qin, Wang Hui-xian

机构信息

Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing 100853, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2010 Jun;49(6):480-3.

PMID:20979733

Abstract

OBJECTIVE

To study the outcomes and influencing factors of the conversion from normal glucose tolerance-hyperinsulinemia (NGT-HINS) to diabetes in the population of a community in Beijing.

METHODS

All the subjects investigated received 75 g oral glucose tolerance test (OGTT) for diabetes screening carried out in May, 2006 and May, 2008. Data were calculated to analyze the outcomes and influencing factors of the conversion. HINS was diagnosed if fasting serum insulin≥15 mIU/L and/or 2-hour serum insulin after glucose loading≥80 mIU/L.

RESULTS

The prevalence of NGT-HINS in the community in 2006 and 2008 was 5.28% and 8.67% (P<0.01) respectively and that of diabetes mellitus (DM) and impaired glucose regulation (IGR) was 3.52%, 6.56% in 2006 and 4.42%, 6.47% in 2008. The probability of the conversion from NGT-HINS to IGR and DM was 18.6% and 2.3%, being much higher than that from normal glucose tolerance-normoinsulinemia (NGT-NINS) (5.4% and 0.7%, P<0.01). However, the probability of the conversion from NGT-HINS to DM was 2.3%, which was much lower than that from IGR (26.3%, P<0.01). The reason might be that individuals with NGT-HINS had a higher waist circumference, BMI, fasting plasma glucose, 2 h plasma glucose and TG but a lower HDL-C than individuals with NGT-NINS in 2006. The HOMA β-cell function index/HOMA insulin resistance index (HBCI/IR) of individuals with NGT-HINS was much lower than that of individuals with NGT-NINS, but much higher than that of individuals with IGR. Logistic regression analysis showed that age, TG and HBCI/IR were the major influencing factors of the conversion from NGT to glucose metabolic disorders.

CONCLUSIONS

The probability of conversion from NGT to DM was increased remarkably when HINS was diagnosed. The reason might be that individuals with NGT-HINS suffered more metabolic risk factors and had a decreased β-cell function. Therefore, individuals with NGT-HINS should be paid attention to in diabetes prevention study.

摘要

目的

研究北京某社区人群中糖耐量正常-高胰岛素血症（NGT-HINS）向糖尿病转化的结局及影响因素。

方法

所有被调查对象于2006年5月和2008年5月接受75g口服葡萄糖耐量试验（OGTT）以进行糖尿病筛查。计算数据以分析转化的结局及影响因素。若空腹血清胰岛素≥15mIU/L和/或葡萄糖负荷后2小时血清胰岛素≥80mIU/L，则诊断为HINS。

结果

该社区2006年和2008年NGT-HINS的患病率分别为5.28%和8.67%（P<0.01），糖尿病（DM）和糖调节受损（IGR）的患病率在2006年分别为3.52%、6.56%，在2008年分别为4.42%、6.47%。NGT-HINS向IGR和DM转化的概率分别为18.6%和2.3%，远高于糖耐量正常-正常胰岛素血症（NGT-NINS）（5.4%和0.7%，P<0.01）。然而，NGT-HINS向DM转化的概率为2.3%，远低于IGR（26.3%，P<0.01）。原因可能是2006年NGT-HINS个体的腰围、BMI、空腹血糖、2小时血糖和甘油三酯（TG）较高，但高密度脂蛋白胆固醇（HDL-C）较低。NGT-HINS个体的稳态模型评估β细胞功能指数/稳态模型评估胰岛素抵抗指数（HBCI/IR）远低于NGT-NINS个体，但远高于IGR个体。Logistic回归分析显示，年龄、TG和HBCI/IR是NGT向糖代谢紊乱转化的主要影响因素。