有和没有内脏脂肪过多的青年起病2型糖尿病患者的胰岛素敏感性和分泌情况
Insulin sensitivity and secretion in youth onset type 2 diabetes with and without visceral adiposity.
作者信息
Amutha Anandakumar, Ali Mohammed K, Unnikrishnan Ranjit, Anjana Ranjit Mohan, Ranjani Harish, Gokulakrishnan Kuppan, Mohan Viswanathan, Narayan K M Venkat
机构信息
Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre of Education, Gopalapuram, Chennai, India.
Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
出版信息
Diabetes Res Clin Pract. 2015 Jul;109(1):32-9. doi: 10.1016/j.diabres.2015.05.018. Epub 2015 May 12.
AIM
To investigate insulin sensitivity and insulin secretion patterns among Asian Indian youth without and with type 2 diabetes (T2DM-y defined as onset of diabetes at or below 25 years) with normal and high visceral fat (VF) levels.
METHODS
We recruited 74 T2DM-y individuals, within 18 months of diagnosis and compared them to 77 age-matched controls with normal glucose tolerance (NGT). Using L4/L5 abdominal CT images, VF levels were categorized as normal or high according to their median values. Oral glucose tolerance tests (glucose and insulin measures) were used to derive Matsuda index, insulin resistance (HOMA-IR) and oral disposition index (DIo). Relationships between measures of insulin sensitivity and secretion and T2DM-y by VF level were assessed using standardized multinomial regression models.
RESULTS
Participants were categorized into four groups: NGT-normal VF; NGT-high VF; T2DM-normal VF, and T2DM-high VF. Among NGTs, those with high VF had significantly lower insulin sensitivity (0.013 vs.0.019 pM(-1)) and Matsuda index (10.2 vs.13.8), than normal VF. When compared, T2DM-high VF had lowest insulin sensitivity (0.009 vs.0.019, 0.013, 0.012 pM-1; p<0.001), Matsuda index (6.4 vs. 13.8, 10.2, 8.6; p<0.001), OGIS120 (305 vs. 396, 382, 316; p<0.001) and DIo (0.48 vs. 3.75, 3.20, 0.55 mmol/L; p<0.001). At every category of 2 h PG values, NGT-high VF had lower DIo than NGT-normal VF participants. In standardized multinomial models, that included DIo and Matsuda index adjusted for age, gender, BMI, and leptin, DIo (Odds ratio: 0.001; 95%Confidence interval: 0.000-0.020), matsuda index (0.26; 0.07-0.93), age (2.92; 1.18-7.19) and leptin (3.17; 1.12-8.99) were associated with high VF among T2DM.
CONCLUSION
Lower DIo and Matsuda index, younger age and higher leptin were independently associated with high visceral fat among T2DM participants. Also, lower DIo was seen with increasing 2 h PG values even among normal glucose tolerant individuals.
目的
研究亚洲印度裔青年中，内脏脂肪（VF）水平正常和较高的2型糖尿病患者（T2DM-y定义为25岁及以下发病的糖尿病）和非糖尿病患者的胰岛素敏感性及胰岛素分泌模式。
方法
我们招募了74例确诊后18个月内的T2DM-y患者，并将他们与77例年龄匹配的糖耐量正常（NGT）对照者进行比较。使用L4/L5腹部CT图像，根据VF水平的中位数将其分为正常或较高两类。口服葡萄糖耐量试验（测量葡萄糖和胰岛素）用于计算松田指数、胰岛素抵抗（HOMA-IR）和口服处置指数（DIo）。使用标准化多项回归模型评估胰岛素敏感性和分泌指标与不同VF水平的T2DM-y之间的关系。
结果
参与者被分为四组：NGT-正常VF；NGT-高VF；T2DM-正常VF和T2DM-高VF。在NGT组中，高VF者的胰岛素敏感性（0.013对0.019 pM(-1)）和松田指数（10.2对13.8）显著低于正常VF者。相比之下，T2DM-高VF者的胰岛素敏感性最低（0.009对0.019、0.013、0.012 pM-1；p<0.001），松田指数（6.4对13.8、10.2、8.6；p<0.001）、OGIS120（305对396、382、316；p<0.001）和DIo（0.48对3.75、3.20、0.55 mmol/L；p<0.001）。在每一个2小时血糖值类别中，NGT-高VF者的DIo均低于NGT-正常VF参与者。在标准化多项模型中，纳入经年龄、性别、BMI和瘦素调整后的DIo和松田指数，DIo（比值比：0.001；95%置信区间：0.000-0.020）、松田指数（0.26；0.07-0.93）、年龄（2.92；1.18-7.19）和瘦素（3.17；1.12-8.99）与T2DM患者的高VF相关。
结论
较低的DIo和松田指数、较年轻的年龄和较高的瘦素水平与T2DM参与者的高内脏脂肪独立相关。此外，即使在糖耐量正常的个体中，随着2小时血糖值升高，DIo也会降低。
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