Nutrition and Health Sciences Program, Graduate Division of Biomedical and Biological Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
Diabetes Care. 2013 Sep;36(9):2772-8. doi: 10.2337/dc12-2290. Epub 2013 Apr 17.
To examine β-cell function across a spectrum of glycemia among Asian Indians, a population experiencing type 2 diabetes development at young ages despite low BMI.
One-thousand two-hundred sixty-four individuals without known diabetes in the Diabetes Community Lifestyle Improvement Program in Chennai, India, had a 75-g oral glucose tolerance test, with glucose and insulin measured at 0, 30, and 120 min. Type 2 diabetes, isolated impaired fasting glucose (iIFG), isolated impaired glucose tolerance (iIGT), combined impaired fasting glucose and impaired glucose tolerance, and normal glucose tolerance (NGT) were defined by American Diabetes Association guidelines. Measures included insulin resistance and sensitivity (homeostasis model assessment of insulin resistance [HOMA-IR], modified Matsuda Index, 1/fasting insulin) and β-cell function (oral disposition index = [Δ insulin0-30/Δ glucose 0-30] × [1/fasting insulin]).
Mean age was 44.2 years (SD, 9.3) and BMI 27.4 kg/m(2) (SD, 3.8); 341 individuals had NGT, 672 had iIFG, IGT, or IFG plus IGT, and 251 had diabetes. Patterns of insulin resistance or sensitivity were similar across glycemic categories. With mild dysglycemia, the absolute differences in age- and sex-adjusted oral disposition index (NGT vs. iIFG, 38%; NGT vs. iIGT, 32%) were greater than the differences in HOMA-IR (NGT vs. iIFG, 25%; NGT vs. iIGT, 23%; each P < 0.0001). Compared with NGT and adjusted for age, sex, BMI, waist circumference, and family history, the odds of mild dysglycemia were more significant per SD of oral disposition index (iIFG: odds ratio [OR], 0.36; 95% CI, 0.23-0.55; iIGT: OR, 0.37; 95% CI, 0.24-0.56) than per SD of HOMA-IR (iIFG: OR, 1.69; 95% CI, 1.23-2.33; iIGT: OR, 1.53; 95% CI, 1.11-2.11).
Asian Indians with mild dysglycemia have reduced β-cell function, regardless of age, adiposity, insulin sensitivity, or family history. Strategies in diabetes prevention should minimize loss of β-cell function.
在亚洲人群中，研究血糖谱范围内的β细胞功能，该人群尽管 BMI 较低，但 2 型糖尿病的发病年龄较早。
在印度钦奈的糖尿病社区生活方式改善计划中，1264 名无已知糖尿病的个体接受了 75g 口服葡萄糖耐量试验，分别在 0、30 和 120 分钟测量血糖和胰岛素。根据美国糖尿病协会的指南，将 2 型糖尿病、单纯空腹血糖受损（iIFG）、单纯糖耐量受损（iIGT）、空腹血糖受损和糖耐量受损联合及正常糖耐量（NGT）定义。评估指标包括胰岛素抵抗和敏感性（稳态模型评估的胰岛素抵抗[HOMA-IR]、改良 Matsuda 指数、1/空腹胰岛素）和β细胞功能（口服处置指数=[Δ胰岛素 0-30/Δ血糖 0-30]×[1/空腹胰岛素]）。
平均年龄为 44.2 岁（标准差，9.3），BMI 为 27.4kg/m²（标准差，3.8）；341 名个体为 NGT，672 名个体为 iIFG、IGT 或 IFG 加 IGT，251 名个体为糖尿病。在不同的血糖类别中，胰岛素抵抗或敏感性模式相似。在轻度糖调节受损时，年龄和性别校正后的口服处置指数（NGT 与 iIFG，38%；NGT 与 iIGT，32%）的绝对差异大于 HOMA-IR（NGT 与 iIFG，25%；NGT 与 iIGT，23%；均 P＜0.0001）。与 NGT 相比，且经年龄、性别、BMI、腰围和家族史校正后，轻度糖调节受损的个体每标准差的口服处置指数（iIFG：比值比[OR]，0.36；95%可信区间[CI]，0.23-0.55；iIGT：OR，0.37；95%CI，0.24-0.56）比 HOMA-IR（iIFG：OR，1.69；95%CI，1.23-2.33；iIGT：OR，1.53；95%CI，1.11-2.11）更显著（均 P＜0.0001）。
无论年龄、肥胖、胰岛素敏感性或家族史如何，患有轻度糖调节受损的亚洲个体的β细胞功能均降低。糖尿病预防策略应尽量减少β细胞功能的丧失。
