Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Pediatr. 2012 Jun;160(6):904-10. doi: 10.1016/j.jpeds.2011.12.002. Epub 2012 Jan 10.
To compare β-cell function in adolescents and adults with newly diagnosed type 2 diabetes (T2DM).
Thirty-nine adolescents with T2DM, 38 age- and weight-matched control subjects, and 19 adults with T2DM were studied. The adolescent subjects with diabetes were divided on the basis of whether they needed insulin to control their initial hyperglycemia. The primary outcome variable was the disposition index, computed from the acute insulin response to glucose corrected for insulin sensitivity (1/Homeostatic model assessment of insulin resistance).
The disposition index was significantly reduced in all 3 diabetic groups (control n=3360, adolescents with T2DM without insulin n=630, adolescents with T2DM with insulin n=120, adults with T2DM n=200; P<.001), and the adolescents with more severe hyperglycemia at diagnosis had lower disposition index than those with a more modest presentation (P<.05).
At the time of diagnosis, adolescents with T2DM have significant β-cell dysfunction, comparable with adults newly diagnosed with T2DM. Thus, severe β-cell impairment can develop within the first two decades of life and is likely to play a central role in the pathogenesis of T2DM in adolescents.
比较新诊断的 2 型糖尿病（T2DM）青少年和成年人的胰岛β细胞功能。
研究了 39 名青少年 T2DM 患者、38 名年龄和体重匹配的对照组和 19 名成人 T2DM 患者。根据糖尿病青少年患者是否需要胰岛素控制初始高血糖，将其分为两组。主要观察变量是胰岛β细胞分泌指数，根据葡萄糖刺激的胰岛素反应校正胰岛素敏感性（1/稳态模型评估的胰岛素抵抗）来计算。
所有 3 组糖尿病患者的胰岛β细胞分泌指数均显著降低（对照组 n=3360，无胰岛素的青少年 T2DM 患者 n=630，有胰岛素的青少年 T2DM 患者 n=120，成人 T2DM 患者 n=200；P<.001），诊断时血糖升高更严重的青少年患者的胰岛β细胞分泌指数低于血糖升高程度较轻的患者（P<.05）。
在诊断时，青少年 T2DM 患者就已经存在明显的胰岛β细胞功能障碍，与新诊断的成人 T2DM 患者相当。因此，严重的胰岛β细胞功能障碍可能在生命的头 20 年内就已经发生，并可能在青少年 2 型糖尿病的发病机制中发挥核心作用。
