通过葡萄糖钳夹研究评估的1型糖尿病患者的胰岛素抵抗：系统评价和荟萃分析。
Insulin resistance in patients with type 1 diabetes assessed by glucose clamp studies: systematic review and meta-analysis.
作者信息
Donga Esther, Dekkers Olaf M, Corssmit Eleonora P M, Romijn Johannes A
机构信息
Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Endocrinology and Metabolic Diseases C7Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Internal MedicineAmsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
出版信息
Eur J Endocrinol. 2015 Jul;173(1):101-9. doi: 10.1530/EJE-14-0911. Epub 2015 Apr 21.
OBJECTIVE
The aim of this study was to perform a systematic review and meta-analysis on insulin resistance in adult patients with type 1 diabetes mellitus compared to healthy controls, assessed by hyperinsulinemic euglycemic clamp studies.
DESIGN AND METHODS
We conducted a systematic search of publications using PubMed, EMBASE, Web of Science and COCHRANE Library. Hyperinsulinemic euglycemic clamp studies comparing adult patients with type 1 diabetes mellitus to healthy controls were eligible. Primary outcome measures were pooled mean differences of insulin sensitivity of endogenous glucose production (EGP), of glucose uptake and of lipolysis. We estimated mean (standardized) differences and 95% CIs using random effects meta-analysis.
RESULTS
We included 38 publications in this meta-analysis. The weighed mean differences in EGP during hyperinsulinemia between patients and controls was 0.88 (95% CI: 0.47, 1.29) in the basal state and 0.52 (95% CI: 0.09, 0.95) in insulin stimulated conditions, indicating decreased hepatic insulin sensitivity in patients. Insulin sensitivity of glucose uptake was either reported as M value (M), glucose infusion rate (GIR), glucose disposal rate (GDR) or metabolic clearance rate (MCR). Weighed mean differences were similar for M -3.98 (95% CI: -4.68, -3.29) and GIR -4.61 (95% CI: -5.86, -3.53). Weighed mean difference for GDR was -2.43 (95% CI: -3.03, -1.83) and -3.29 (95% CI: -5.37, -1.22) for MCR, indicating decreased peripheral insulin sensitivity in patients. Insulin mediated inhibition of lipolysis was decreased in patients, reflected by increased non-esterified fatty acid levels.
CONCLUSIONS
Insulin resistance is a prominent feature of patients with type 1 diabetes mellitus and involves hepatic, peripheral and adipose tissues.
目的
本研究旨在通过高胰岛素正常血糖钳夹试验，对1型糖尿病成年患者与健康对照者的胰岛素抵抗进行系统评价和荟萃分析。
设计与方法
我们使用PubMed、EMBASE、Web of Science和COCHRANE图书馆对出版物进行了系统检索。比较1型糖尿病成年患者与健康对照者的高胰岛素正常血糖钳夹试验符合要求。主要结局指标为内源性葡萄糖生成（EGP）、葡萄糖摄取和脂肪分解的胰岛素敏感性合并平均差异。我们使用随机效应荟萃分析估计平均（标准化）差异和95%置信区间。
结果
本荟萃分析纳入了38篇出版物。患者与对照者在基础状态下高胰岛素血症期间EGP的加权平均差异为0.88（95%置信区间：0.47，1.29），在胰岛素刺激条件下为0.52（95%置信区间：0.09，0.95），表明患者肝脏胰岛素敏感性降低。葡萄糖摄取的胰岛素敏感性报告为M值（M）、葡萄糖输注率（GIR）、葡萄糖处置率（GDR）或代谢清除率（MCR）。M的加权平均差异为-3.98（95%置信区间：-4.68，-3.29），GIR为-4.61（95%置信区间：-5.86，-3.53），二者相似。GDR的加权平均差异为-2.43（95%置信区间：-3.03，-1.83），MCR为-3.29（95%置信区间：-5.37，-1.22），表明患者外周胰岛素敏感性降低。患者胰岛素介导的脂肪分解抑制作用降低，表现为非酯化脂肪酸水平升高。
结论
胰岛素抵抗是1型糖尿病患者的一个突出特征，涉及肝脏、外周和脂肪组织。
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