Son Jang Won, Jeong Hee Kyoung, Lee Seong Su, Kim Sung Rae, Cha Bong-Yun, Son Ho-Young, Yoo Soon Jib
a Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea , Bucheon, Korea.
b Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea , Seoul, Korea.
Endocr Res. 2013 Aug;38(3):160-167. doi: 10.3109/07435800.2012.745870. Epub 2013 Jan 3.
The aim of this study was to evaluate the effects of early intensive insulin therapy on body fat distribution, lean body mass and β-cell function in patients with newly diagnosed type 2 diabetes.
Thirty-eight subjects with newly diagnosed type 2 diabetes participated in a 12-week course of intensive insulin therapy. Patients were administered a 75 g oral glucose tolerance test (OGTT), underwent measurement of visceral and subcutaneous adipose tissues (VAT and SAT) using computed tomography and appendicular skeletal muscle (ASM) mass was assessed using dual-energy X-ray absorptiometry.
After intensive insulin therapy, fasting plasma glucose and HbA1c levels decreased. Homeostasis model assessment (HOMA)-B, the insulinogenic index, and the C-peptide-to-glucose area under the curve (AUC) ratio increased. The insulin sensitivity index and the glucose AUC decreased after 12 weeks. The body composition analysis revealed that the VAT and the ratio of VAT to SAT decreased, whereas body weight and total fat mass increased nonsignificantly. The ASM/weight and skeletal muscle mass index increased. The restoration of β-cell function, as identified by HOMA-B, the insulinogenic index, and the C-peptide-to-glucose AUC ratio, was correlated with the changes in VAT when controlled for age and gender. In multiple regression analyses, the decrease in VAT was shown to independently contribute to improved HbA1c over the study period, after adjusting for confounding factors.
These results suggest that a shift in fat distribution from visceral to subcutaneous fat after early intensive insulin therapy is associated with improvements in glycemic control and β-cell function in patients with newly diagnosed type 2 diabetes.
本研究旨在评估早期强化胰岛素治疗对新诊断2型糖尿病患者体脂分布、瘦体重及β细胞功能的影响。
38例新诊断的2型糖尿病患者参加了为期12周的强化胰岛素治疗疗程。患者接受了75g口服葡萄糖耐量试验（OGTT），采用计算机断层扫描测量内脏和皮下脂肪组织（VAT和SAT），并使用双能X线吸收法评估四肢骨骼肌（ASM）质量。
强化胰岛素治疗后，空腹血糖和糖化血红蛋白水平降低。稳态模型评估（HOMA）-B、胰岛素生成指数以及C肽与葡萄糖曲线下面积（AUC）比值升高。12周后胰岛素敏感性指数和葡萄糖AUC降低。身体成分分析显示，VAT以及VAT与SAT的比值降低，而体重和总脂肪量无显著增加。ASM/体重和骨骼肌质量指数升高。当控制年龄和性别时，通过HOMA-B、胰岛素生成指数以及C肽与葡萄糖AUC比值确定的β细胞功能恢复与VAT的变化相关。在多元回归分析中，调整混杂因素后，VAT的降低在研究期间独立地有助于改善糖化血红蛋白。
这些结果表明，早期强化胰岛素治疗后脂肪分布从内脏脂肪向皮下脂肪的转变与新诊断2型糖尿病患者血糖控制和β细胞功能的改善相关。
