Preethi B L, Jaisri G, Kumar K M Prasanna, Sharma Rajeev
M.S. Ramaiah Medical College & Hospital, Bangalore, Karataka State, India.
Fiziol Cheloveka. 2011 Jan-Feb;37(1):118-25.
Detection of Insulin resistance (IR) in normoglycemic young subjects before the onset of Impaired Glucose Tolerance (IGT) is of importance as it affords implementation of preventive measures in such high risk subject. Very few studies have specifically evaluated for the presence of IR in younger age group with normal glucose tolerance. The gold standard for investigating and quantifying insulin resistance is the "hyperinsulinemic euglycemic clamp," the complicated nature of the "clamp" technique, alternatives have been sought to simplify the measurement of insulin resistance. The oral glucose tolerance test (OGTT) is one of the most commonly used methods to evaluate whole body glucose tolerance in vivo. IR & IS values of HOMA-IR, ISI 0-120, QUICKIE mathematical models derived from OGTT have been shown to produce equivalent results as in Euglycemic clamp technique we hypothesized that normoglycemic young adult who are siblings of type II diabetics (SD) probably have higher IR values than the siblings of non diabetics as they are genetically predisposed. In this study 79 normal young adult volunteers, 40 subjects with family history of diabetes (SD) and 39 subjects without family history of diabetes (SND), in the age range of 18 to 25 years were evaluated for Insulin resistance. Standard (75 g) OGTT was performed on all the study subjects after an overnight fast. Fasting (basal), 30, 120 min venous plasma glucose & Corresponding specific insulin concentration was determined by radioimmuno assay (RIA) using a human specific antibody RIA kit. In each subject, the degree of insulin resistance was estimated by various parameters of Insulin resistance & sensitivity that were calculated using physiological mathematical models like HOMA-IR, ISI0-120, IGI, QUICKIE and their formulas derived from OGTT. The mean age of the study population was 19.01 (18 to 25 years), Male: 33 (41.3%) and Female: 47 (58.8%). The normoglycemic subjects were categorized as Siblings of Diabetics (SD n = 40) and siblings of non-diabetics(SND n = 39). Both the groups were matched by physical, clinical and routine laboratory parameters and were not statistically significant different. Siblings of diabetics had a statistically significant higher values of insulin at baseline, 30 min & 120 minutes and glucose at 30 minutes. Siblings of diabetics had a significantly higher insulin resistance and lower insulin sensitivity indices as in HOMA-IR (2.01527, p < 0.017), ISIO-120 (56.27, p < 0.002) and I0/G0 ratio (0.122381, p < 0.012) and a trend towards significance for QUICKIE(0.29578, p < 0.056). Detection of insulin resistance in normoglycemic young adult subjects in pre-disease state is feasible using mathematical models like HOMA IR, ISIO-120 from OGTT. OGTT is simple and a generally acceptable test. Siblings of diabetics had higher Insulin resistance values and lower Insulin sensitivity values. Physiological models like HOMA IR, QUICKIE, I0/G0 ratio, IGI, ISIO-120 are simple & cost effective method for screening Insulin resistance. Diagnosis of Insulin resistance in pre-disease state allows initiation of preventive measures like life style modification, diet & exercise, thereby preventing the high risk subjects from progressing to disease state.
在糖耐量受损（IGT）发作之前检测血糖正常的年轻受试者的胰岛素抵抗（IR）具有重要意义，因为这能在这类高危受试者中实施预防措施。很少有研究专门评估葡萄糖耐量正常的年轻人群中IR的存在情况。研究和量化胰岛素抵抗的金标准是“高胰岛素正常血糖钳夹技术”，由于“钳夹”技术复杂，人们一直在寻找简化胰岛素抵抗测量的替代方法。口服葡萄糖耐量试验（OGTT）是体内评估全身葡萄糖耐量最常用的方法之一。源自OGTT的HOMA-IR、ISI 0-120、QUICKI数学模型的IR和IS值已被证明能产生与正常血糖钳夹技术等效的结果。我们假设，作为II型糖尿病患者兄弟姐妹（SD）的血糖正常的年轻成年人可能比非糖尿病患者的兄弟姐妹具有更高的IR值，因为他们有遗传易感性。在本研究中，对79名年龄在18至25岁的正常年轻成人志愿者、40名有糖尿病家族史的受试者（SD）和39名无糖尿病家族史的受试者（SND）进行了胰岛素抵抗评估。所有研究对象在隔夜禁食后进行标准（75克）OGTT。空腹（基础）、30分钟、120分钟时的静脉血浆葡萄糖及相应的特异性胰岛素浓度通过使用人特异性抗体放射免疫分析试剂盒（RIA）进行测定。在每个受试者中，使用源自OGTT的生理数学模型如HOMA-IR、ISI0-120、IGI、QUICKI及其公式计算胰岛素抵抗和敏感性的各种参数，以估计胰岛素抵抗程度。研究人群的平均年龄为19.01岁（18至25岁），男性33名（41.3%），女性47名（58.8%）。血糖正常的受试者被分为糖尿病患者的兄弟姐妹（SD，n = 40）和非糖尿病患者的兄弟姐妹（SND，n = 39）。两组在身体、临床和常规实验室参数方面相匹配，且无统计学显著差异。糖尿病患者的兄弟姐妹在基线、30分钟和120分钟时的胰岛素值以及30分钟时的血糖值在统计学上显著更高。糖尿病患者的兄弟姐妹具有显著更高的胰岛素抵抗和更低的胰岛素敏感性指数，如HOMA-IR（2.01527，p < 0.017）、ISIO-120（56.27，p < 0.002）和I0/G0比值（0.122381，p < 0.012），QUICKI有显著趋势（0.29578，p < 0.056）。使用源自OGTT的HOMA IR、ISIO-120等数学模型在疾病前期状态检测血糖正常的年轻成人受试者的胰岛素抵抗是可行的。OGTT简单且是普遍可接受的检测方法。糖尿病患者的兄弟姐妹具有更高的胰岛素抵抗值和更低的胰岛素敏感性值。像HOMA IR、QUICKI、I0/G0比值、IGI、ISIO-120这样的生理模型是筛查胰岛素抵抗的简单且经济有效的方法。在疾病前期状态诊断胰岛素抵抗可启动如生活方式改变、饮食和运动等预防措施，从而防止高危受试者发展为疾病状态。
