Diabetes Division, Department of Medicine I, St Josef Hospital, Ruhr University Bochum, Gudrunstr 56, 44791 Bochum, Germany.
Diabetologia. 2012 May;55(5):1346-54. doi: 10.1007/s00125-012-2466-8.
AIMS/HYPOTHESIS: Diabetes frequently develops in patients with pancreatic disorders. We aimed to determine the lower threshold of beta cell area for diabetes manifestation as well as the impact of insulin sensitivity on glucose homoeostasis in patients with pancreatic diabetes.
Eighty-two patients undergoing pancreatic surgery underwent pre-operative oral glucose challenge. Fractional pancreatic beta cell area was determined, and indices of insulin sensitivity and beta cell function were calculated.
HbA1c and glucose levels were similar in patients with high and intermediate beta cell area, but were significantly higher in those with the lowest beta cell area (p < 0.0001). Insulin secretion was reduced only in patients with the lowest beta cell area (p < 0.001). The relative beta cell deficits at the onset of diabetes and impaired glucose tolerance were 64% and 21%, respectively, based on 2 h glucose levels. Deteriorating insulin sensitivity was associated with a small increase in the incidence of diabetes.
CONCLUSIONS/INTERPRETATION: In conclusion, pancreatic diabetes probably develops after a reduction in beta cell area of ~65%. Post-challenge glucose excursions are much more closely related to pancreatic beta cell area than to fasting glycaemia, thereby underlining the usefulness of the OGTT in patients with pancreatic disorders.
目的/假设：糖尿病常发生于胰腺疾病患者中。本研究旨在确定β细胞面积的下限值，以预测胰腺糖尿病患者发生糖尿病的可能性，并探讨胰岛素敏感性对葡萄糖稳态的影响。
82 例行胰腺手术的患者接受术前口服葡萄糖耐量试验。测定患者的β细胞面积分数，并计算胰岛素敏感性和β细胞功能指数。
高β细胞面积和中β细胞面积患者的糖化血红蛋白和血糖水平相似，但低β细胞面积患者的血糖水平显著升高（p < 0.0001）。仅低β细胞面积患者的胰岛素分泌减少（p < 0.001）。基于 2 h 血糖水平，糖尿病和糖耐量受损患者发病时的相对β细胞缺陷分别为 64%和 21%。胰岛素敏感性恶化与糖尿病发病率的轻微增加相关。
胰腺糖尿病可能发生于β细胞面积减少约 65%之后。葡萄糖负荷后血糖波动与β细胞面积的相关性比空腹血糖更高，因此强调了 OGTT 在胰腺疾病患者中的应用价值。
