Chen G, Shi L, Cai L, Lin W, Huang H, Liang J, Li L, Lin L, Tang K, Chen L, Lu J, Bi Y, Wang W, Ning G, Wen J
Department of Endocrinology, Fujian Provincial Hospital, Fujian Academy of Medical Sciences, Fujian Medical University, Fuzhou, China.
Department of Endocrinology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Horm Metab Res. 2017 Feb;49(2):135-141. doi: 10.1055/s-0042-111325. Epub 2016 Jul 26.
Insulin resistance and β-cell function are different between the young and elderly diabetes individuals, which are not well elaborated in the nondiabetic persons. The aims of this study were to compare insulin resistance and β-cell function between young and old adults from normal glucose tolerance (NGT) to prediabetes [which was subdivided into isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and a combination of both (IFG/IGT)], and compare the prevalence of diabetes mellitus (DM) in the above prediabetes subgroups between different age groups after 3 years. A total of 1 374 subjects aged below 40 or above 60 years old with NGT or prediabetes were finally included in this study. Insulin resistance and β-cell function from homeostasis model assessment (HOMA) and interactive, 24-variable homeostatic model of assessment (iHOMA2) were compared between different age groups. The rate of transition to diabetes between different age groups in all pre-diabetes subgroups was also compared. Compared with the old groups, young i-IFG and IFG/IGT groups exhibit higher log HOMA-IR and log HOMA2-S, whereas the young i-IGT groups experienced comparable log HOMA-IR and log HOMA2-S when compared with old i-IFG and IFG/IGT groups. Three prediabetes subgroups all had similar log HOMA-B and log HOMA2-B between different age groups. In addition, the prevalence of diabetes in young i-IFG was statistically higher than that in old i-IFG after 3 years. Age is negatively related to log HOMA2-B in both age groups. Considering an age-related deterioration of β-cell function, young i-IFG, young i-IGT, and young IFG/IGT all suffered a greater impairment in insulin secretion than the old groups. Young i-IFG and IFG/IGT have more severe insulin resistance than the old groups. In addition, young i-IFG characterized with a higher incidence of DM than the old i-IFG. These disparities highlight that the prevention to slow progression from prediabetes to type 2 diabetes should be additionally focused in young prediabetes individuals, especially young i-IFG.
胰岛素抵抗和β细胞功能在年轻和老年糖尿病患者中存在差异，而在非糖尿病个体中尚未得到充分阐述。本研究的目的是比较正常糖耐量（NGT）至糖尿病前期[糖尿病前期又细分为单纯空腹血糖受损（i-IFG）、单纯糖耐量受损（i-IGT）以及两者皆有（IFG/IGT）]的年轻人和老年人之间的胰岛素抵抗和β细胞功能，并比较3年后上述糖尿病前期亚组中不同年龄组的糖尿病（DM）患病率。本研究最终纳入了1374名年龄在40岁以下或60岁以上的NGT或糖尿病前期患者。比较了不同年龄组之间基于稳态模型评估（HOMA）和交互式24变量稳态模型评估（iHOMA2）得出的胰岛素抵抗和β细胞功能。还比较了所有糖尿病前期亚组中不同年龄组向糖尿病转变的发生率。与老年组相比，年轻的i-IFG和IFG/IGT组表现出更高的log HOMA-IR和log HOMA2-S，而年轻的i-IGT组与老年的i-IFG和IFG/IGT组相比，log HOMA-IR和log HOMA2-S相当。三个糖尿病前期亚组在不同年龄组之间的log HOMA-B和log HOMA2-B均相似。此外，3年后年轻i-IFG组的糖尿病患病率在统计学上高于老年i-IFG组。在两个年龄组中，年龄与log HOMA2-B均呈负相关。考虑到β细胞功能随年龄的恶化，年轻的i-IFG、年轻的i-IGT和年轻的IFG/IGT在胰岛素分泌方面比老年组受损更严重。年轻的i-IFG和IFG/IGT比老年组具有更严重胰岛素抵抗。此外，年轻i-IFG的DM发生率高于老年i-IFG。这些差异突出表明，应特别关注年轻糖尿病前期个体，尤其是年轻i-IFG个体从糖尿病前期向2型糖尿病缓慢进展的预防。
