Bleich D, Jackson R A, Soeldner J S, Eisenbarth G S
Joslin Diabetes Center, Brigham and Women's Hospital, Boston, Massachusetts.
Diabetes Care. 1990 Feb;13(2):111-8. doi: 10.2337/diacare.13.2.111.
We intensively studied 5 islet cell-antibody-positive (ICA+) first-degree relatives of type I (insulin-dependent) diabetic patients before overt diabetes. In total, 55 intravenous glucose tolerance tests (IVGTTs) and 83 fasting plasma glucose determinations were made over a maximum 4-yr period before diabetes. The 5 prediabetic relatives (not diabetic when initially studied but subsequently progressed to overt diabetes) as a group showed a progressive rise in fasting glucose (r = 0.58, P less than 0.001, slope = 23.1 mg.dl-1.yr-1) and glucose at 60 min in IVGTT (r = 0.46, P = 0.01, slope = 47.5 mg.dl-1.yr-1) beginning 1.5 yr before diabetes. During the 4.0- to 1.5-yr period before overt diabetes, no change was observed in fasting glucose or glucose at 60 min on IVGTT (fasting glucose: r = 0.21, P = 0.18, slope = 2.1 mg.dl-1.yr-1; 60-min glucose: r = 0.08, P = 0.72, slope = 2.9 mg.dl-1.yr-1). The positive predictive value for a fasting glucose greater than 108 mg/dl to be within 1.5 yr of diabetes was 100% (11 of 11 values). The negative predictive value of a stimulated insulin (1-min + 3-min insulin - 2 X basal insulin) level greater than 24 microU/ml to be greater than 1.5 yr from diabetes was 90% (9 of 10 values) and 100% (10 of 10 values) at greater than 1 yr from overt diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)
我们对5例1型（胰岛素依赖型）糖尿病患者的胰岛细胞抗体阳性（ICA+）一级亲属在显性糖尿病出现之前进行了深入研究。在糖尿病出现前最长4年的时间里，总共进行了55次静脉葡萄糖耐量试验（IVGTT）和83次空腹血糖测定。5例糖尿病前期亲属（最初研究时未患糖尿病，但随后进展为显性糖尿病）作为一个群体，在糖尿病出现前1.5年开始，空腹血糖呈渐进性升高（r = 0.58，P < 0.001，斜率 = 23.1 mg·dl⁻¹·yr⁻¹），IVGTT中60分钟时的血糖也呈渐进性升高（r = 0.46，P = 0.01，斜率 = 47.5 mg·dl⁻¹·yr⁻¹）。在显性糖尿病出现前4.0至1.5年期间，空腹血糖或IVGTT中60分钟时的血糖未观察到变化（空腹血糖：r = 0.21，P = 0.18，斜率 = 2.1 mg·dl⁻¹·yr⁻¹；60分钟血糖：r = 0.08，P = 0.72，斜率 = 2.9 mg·dl⁻¹·yr⁻¹）。空腹血糖大于108 mg/dl且在糖尿病出现1.5年内的阳性预测值为100%（11个值中的11个）。刺激后胰岛素（1分钟 + 3分钟胰岛素 - 2×基础胰岛素）水平大于24 μU/ml且距离糖尿病超过1.5年的阴性预测值为90%（10个值中的9个）以及距离显性糖尿病超过1年时为100%（10个值中的10个）。（摘要截短于250字）
