Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon.
Diabet Med. 2013 Sep;30(9):1075-9. doi: 10.1111/dme.12201. Epub 2013 Apr 19.
Controversies still exist regarding the relative contributions of insulin resistance and β-cell dysfunction to the pathogenesis of Type 2 diabetes in different populations. We examined the associations of baseline insulin resistance and β-cell function indices with the development of Type 2 diabetes in Koreans.
We analysed the clinical and laboratory data of 17 878 Korean adults (age 20-79 years) who underwent routine medical examinations with a median interval of 3.5 years (range 2.5-4.7 years). Using the homeostasis model assessment, insulin resistance (HOMA-IR) and β-cell function (HOMA-%B) indices at baseline were assessed.
Those who developed diabetes (n = 732, 4.1%) had significantly higher fasting serum insulin level (53.4 ± 31.2 vs. 41.4 ± 23.4 pmol/l) and HOMA-IR (2.38 ± 1.45 vs. 1.65 ± 1.02) and lower HOMA-%B (74 ± 47 vs. 85 ± 48) at baseline (P < 0.001 for all). Both high HOMA-IR and low HOMA-%B were independently associated with an increased odds ratio of incident Type 2 diabetes. Among the participants who developed diabetes, 29% demonstrated predominant β-cell dysfunction (HOMA-%B < 25th percentile) and 51% had predominant insulin resistance (HOMA-IR > 75th percentile). When we divided the participants according to the median BMI of the whole population (23.7 kg/m²), 49% of participants in the low BMI group demonstrated predominant β-cell dysfunction and 26% had predominant insulin resistance, whilst 21% in the high BMI group demonstrated mainly β-cell dysfunction and 60% had mainly insulin resistance.
In individuals with low BMI, β-cell dysfunction is the predominant defect, whereas insulin resistance is the predominant pathogenetic factor in individuals with high BMI in the development of Type 2 diabetes in Koreans.
关于胰岛素抵抗和β细胞功能障碍对不同人群 2 型糖尿病发病机制的相对贡献，仍存在争议。我们研究了基线胰岛素抵抗和β细胞功能指数与韩国人 2 型糖尿病发病的关系。
我们分析了 17878 名韩国成年人（年龄 20-79 岁）的临床和实验室数据，这些人接受了常规体检，中位随访间隔为 3.5 年（范围 2.5-4.7 年）。使用稳态模型评估，评估基线时的胰岛素抵抗（HOMA-IR）和β细胞功能（HOMA-%B）指数。
发展为糖尿病的患者（n=732，4.1%）的空腹血清胰岛素水平（53.4±31.2 vs. 41.4±23.4 pmol/l）和 HOMA-IR（2.38±1.45 vs. 1.65±1.02）明显较高，HOMA-%B（74±47 vs. 85±48）明显较低（所有 P<0.001）。高 HOMA-IR 和低 HOMA-%B 均与 2 型糖尿病发病的比值比增加独立相关。在发展为糖尿病的患者中，29%表现为主要的β细胞功能障碍（HOMA-%B<第 25 百分位数），51%表现为主要的胰岛素抵抗（HOMA-IR>第 75 百分位数）。当我们根据整个人群的中位数 BMI（23.7 kg/m²）将参与者分组时，低 BMI 组中 49%的参与者表现为主要的β细胞功能障碍，26%的参与者表现为主要的胰岛素抵抗，而高 BMI 组中 21%的参与者主要表现为β细胞功能障碍，60%的参与者主要表现为胰岛素抵抗。
在低 BMI 的个体中，β细胞功能障碍是主要缺陷，而在高 BMI 的个体中，胰岛素抵抗是 2 型糖尿病发病的主要致病因素。
