β 细胞功能和胰岛素抵抗与亚洲印第安人青年 2 型糖尿病和糖尿病前期的相关性。
Associations of β-cell function and insulin resistance with youth-onset type 2 diabetes and prediabetes among Asian Indians.
机构信息
Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre for Education, Gopalapuram, Chennai, India.
出版信息
Diabetes Technol Ther. 2013 Apr;15(4):315-22. doi: 10.1089/dia.2012.0259. Epub 2013 Mar 13.
AIM
This study examined β-cell function and insulin resistance (homeostasis model assessment-insulin resistance [HOMA-IR]) in Asian Indian youth with type 2 diabetes mellitus (T2DM-Y) and prediabetes.
SUBJECTS AND METHODS
Eighty-two subjects with non-insulin-requiring type 2 diabetes and age of onset below 25 years were recruited within 18 months of diagnosis and compared with age- and sex-matched subjects with prediabetes (n=31) and normal glucose tolerance (NGT) (n = 83). Body mass index (BMI) and waist circumference were measured, and blood samples were taken in the fasting state and after 30, 60, 90, and 120 min of an oral glucose load for assessment of plasma glucose and insulin levels. Insulin sensitivity/resistance measures was calculated by using the reciprocal of the fasting insulin, the HOMA-IR equation, and the composite whole body insulin sensitivity index (Matsuda Index), and β-cell function was calculated by the oral disposition index (DIo).
RESULTS
T2DM-Y and prediabetes subjects had higher BMI, waist circumference, and fasting insulin than NGT subjects (P<0.05 for each). The 30-min insulin levels were lower in T2DM-Y and higher in prediabetes subjects compared with NGT (57 and 140 vs. 129 μIU/mL, P<0.001). The T2DM-Y group had greater insulin resistance (HOMA-IR, 1.87 vs. 0.97; P<0.05) and lower β-cell function (DIo, 0.36 vs. 3.28; P<0.001) than NGT. In separate models, the Matsuda Index and DIo were independently associated with prediabetes and T2DM-Y (P<0.05). However, when both were included together, only DIo remained associated with T2DM-Y, whereas both DIo and Matsuda Index were associated with prediabetes (P<0.05). When controlled for adiposity (BMI and waist circumference), an association was observed but in opposite directions, with waist being positively associated with prediabetes (P = 0.016) and BMI negatively associated with T2DM-Y (P = 0.009).
CONCLUSIONS
Among Asian Indians, β-cell dysfunction appears to be more strongly associated with T2DM-Y than insulin resistance.
目的
本研究旨在探讨伴有 2 型糖尿病（T2DM-Y）和糖尿病前期的亚洲印度裔青年的胰岛β细胞功能和胰岛素抵抗（稳态模型评估的胰岛素抵抗[HOMA-IR]）。
受试者和方法
在诊断后 18 个月内，招募了 82 名非胰岛素依赖型 2 型糖尿病且发病年龄低于 25 岁的受试者，并将其与年龄和性别匹配的糖尿病前期（n=31）和正常糖耐量（NGT）（n=83）受试者进行比较。测量体重指数（BMI）和腰围，并在空腹和口服葡萄糖负荷后 30、60、90 和 120 分钟时采集血样，以评估血浆葡萄糖和胰岛素水平。采用空腹胰岛素的倒数、HOMA-IR 方程和整体胰岛素敏感性综合指数（Matsuda 指数）来计算胰岛素敏感性/抵抗指标，采用口服葡萄糖处置指数（DIo）来计算胰岛β细胞功能。
结果
与 NGT 受试者相比，T2DM-Y 和糖尿病前期受试者的 BMI、腰围和空腹胰岛素水平更高（P<0.05）。与 NGT 相比，T2DM-Y 和糖尿病前期受试者的 30 分钟胰岛素水平更低（57 和 140 比 129 μIU/mL，P<0.001）。与 NGT 相比，T2DM-Y 组的胰岛素抵抗（HOMA-IR，1.87 比 0.97；P<0.05）和胰岛β细胞功能（DIo，0.36 比 3.28；P<0.001）更低。在单独的模型中，Matsuda 指数和 DIo 与糖尿病前期和 T2DM-Y 均独立相关（P<0.05）。然而，当同时纳入这两个指标时，只有 DIo 与 T2DM-Y 相关，而 DIo 和 Matsuda 指数均与糖尿病前期相关（P<0.05）。在控制肥胖（BMI 和腰围）后，观察到了相关性，但方向相反，腰围与糖尿病前期呈正相关（P=0.016），BMI 与 T2DM-Y 呈负相关（P=0.009）。
结论
在亚洲印度人中，与胰岛素抵抗相比，胰岛β细胞功能障碍似乎与 T2DM-Y 更密切相关。
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