Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
J Gerontol A Biol Sci Med Sci. 2012 Dec;67(12):1300-6. doi: 10.1093/gerona/glr141. Epub 2011 Aug 26.
We examined women in their 80s and 90s and evaluated the hypothesis that abnormalities in the dynamic response of glucose and insulin to a glucose load are associated with frailty status.
We performed a 75 g oral glucose tolerance test in 73 community-dwelling women aged 84-95 years without known diabetes enrolled in the Women's Health and Aging Study II. We examined the association of frailty status (nonfrail, prefrail, or frail) with oral glucose tolerance test glucose and insulin levels at 0, 30, 60, 120, and 180 minutes using multiple linear regression models.
Using American Diabetes Association criteria, only 27% of older women had normal glucose status, 48% had prediabetes, and 25% had undiagnosed diabetes. Fasting glucose, fasting insulin, homeostasis model of assessment-insulin resistance, and Matsuda index were similar by frailty status, adjusting for age and body mass index. Conversely, mean oral glucose tolerance test glucose levels were higher at 60 minutes (44.6 ± 18.1 mg/dL higher) and 120 minutes (67.1 ± 23.5 mg/dL higher) and to a lesser extent at 180 minutes (44.3 ± 22.5 mg/dL higher) in frail versus nonfrail women as was integrated glucose area after adjustment. Mean 120-minute insulin level was also higher in frail versus nonfrail women (45.7 ± 22.4 μU/mL higher). Overall, glucose and insulin responses were more exaggerated and prolonged in frail versus nonfrail or prefrail women.
Our data demonstrate dysregulation in response to glucose challenge as a component of physiologic vulnerability associated with frailty in old-old women. Future studies should examine the timing of abnormal glucose-insulin dynamics with respect to the pathogenesis of frailty.
我们研究了 80 多岁和 90 多岁的女性，并评估了以下假设，即葡萄糖和胰岛素对葡萄糖负荷的动态反应异常与虚弱状态有关。
我们对参加妇女健康与衰老研究 II 的 73 名年龄在 84-95 岁之间、无已知糖尿病的社区居住女性进行了 75 克口服葡萄糖耐量试验。我们使用多线性回归模型，检查虚弱状态（非虚弱、虚弱前期或虚弱）与口服葡萄糖耐量试验 0、30、60、120 和 180 分钟时的葡萄糖和胰岛素水平之间的关联。
根据美国糖尿病协会的标准，只有 27%的老年女性血糖正常，48%患有糖尿病前期，25%患有未确诊的糖尿病。调整年龄和体重指数后，空腹血糖、空腹胰岛素、评估胰岛素抵抗的稳态模型和 Matsuda 指数在虚弱状态上相似。相反，与非虚弱女性相比，在 60 分钟（高 44.6 ± 18.1mg/dL）和 120 分钟（高 67.1 ± 23.5mg/dL）时，平均口服葡萄糖耐量试验葡萄糖水平更高，在 180 分钟（高 44.3 ± 22.5mg/dL）时程度较低，经调整后葡萄糖面积也更高。与非虚弱女性相比，120 分钟时平均胰岛素水平也更高（高 45.7 ± 22.4μU/mL）。总的来说，与非虚弱或虚弱前期女性相比，虚弱女性的葡萄糖和胰岛素反应更加明显和持久。
我们的数据表明，葡萄糖负荷反应失调是与老年女性虚弱相关的生理脆弱性的一个组成部分。未来的研究应该检查异常葡萄糖-胰岛素动力学与虚弱发病机制的关系。
