Meng Li-Heng, Huang Yao, Zhou Jia, Liang Xing-Huan, Xian Jing, Li Li, Qin Ying-Fen
Department of Endocrine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
Chin Med J (Engl). 2017 Apr 5;130(7):798-804. doi: 10.4103/0366-6999.202739.
A relationship between hyperthyroidism and insulin secretion in type 2 diabetes mellitus (T2DM) has been reported. Therefore, this study explored the use of first-phase insulin secretion in the differential diagnosis of thyroid diabetes (TDM) and T2DM.
In total, 101 patients with hyperthyroidism were divided into hyperthyroidism with normal glucose tolerance (TNGT), hyperthyroidism with impaired glucose regulation (TIGR), and diabetes (TDM) groups. Furthermore, 96 patients without hyperthyroidism were recruited as control groups (normal glucose tolerance [NGT], impaired glucose regulation [IGR], and T2DM). The following parameters were evaluated: homeostasis model assessment (HOMA)-IR, HOMA-β, modified β-cell function index (MBCI), peak insulin/fasting insulin (IP/I0), AUCins-OGTT, and AUCins-OGTT/AUCglu-OGTTfrom the oral glucose tolerance test (OGTT) insulin release test were utilized to assess the second-phase insulin secretion, while the IP/I0, AIR0'~10', and AUCins-IVGTTfrom the intravenous glucose tolerance test (IVGTT) insulin release test were used to assess the first-phase insulin secretion.
In the OGTT, the HOMA-β values of the TNGT and TDM groups were higher than those of the NGT and T2DM groups (all P< 0.05). In the hyperthyroidism groups, the MBCI of the TDM group was lower than that of the TNGT and TIGR groups (all P< 0.05). Among the control groups, the MBCI values of the IGR and T2DM groups were lower than that of the normal glucose tolerance (NGT) group (all P< 0.05). In the IVGTT, insulin secretion peaked for all groups at 2-4 min, except for the T2DM group, which showed a low plateau and no secretion peak. The IP values of the TNGT, TIGR, and TDM groups were higher than those of the NGT, IGR, and T2DM groups (all P< 0.05). The Ip/I0, AIR0'10', and AUCins-IVGTTvalues of the TDM group were higher than those of the T2DM group but were lower than those of the TNGT, TIGR, NGR, and IGR groups (all P< 0.05). Compared with the other five groups, the Ip/I0, AIR0'10', and AUCins-IVGTTvalues of the T2DM group were significantly decreased (all P< 0.05). The Ip/I0and AUCins-IVGTTvalues of the TNGT group were higher than those of the NGT group (all P< 0.05).
β-cell function in TDM patients is superior to that in T2DM patients. First-phase insulin secretion could be used as an early diagnostic marker to differentiate TDM and T2DM.
有报道称2型糖尿病（T2DM）患者的甲状腺功能亢进与胰岛素分泌之间存在关联。因此，本研究探讨了利用第一相胰岛素分泌来鉴别甲状腺糖尿病（TDM）和T2DM。
总共101例甲状腺功能亢进患者被分为甲状腺功能亢进伴糖耐量正常（TNGT）、甲状腺功能亢进伴糖调节受损（TIGR）和糖尿病（TDM）组。此外，招募了96例无甲状腺功能亢进的患者作为对照组（糖耐量正常[NGT]、糖调节受损[IGR]和T2DM）。评估了以下参数：稳态模型评估（HOMA）-IR、HOMA-β、改良β细胞功能指数（MBCI）、胰岛素峰值/空腹胰岛素（IP/I0）、口服葡萄糖耐量试验（OGTT）胰岛素释放试验的AUCins-OGTT以及AUCins-OGTT/AUCglu-OGTT，用于评估第二相胰岛素分泌，而静脉葡萄糖耐量试验（IVGTT）胰岛素释放试验的IP/I0、AIR0'~10'和AUCins-IVGTT用于评估第一相胰岛素分泌。
在OGTT中，TNGT组和TDM组的HOMA-β值高于NGT组和T2DM组（均P<0.05）。在甲状腺功能亢进组中，TDM组的MBCI低于TNGT组和TIGR组（均P<0.05）。在对照组中，IGR组和T2DM组的MBCI值低于糖耐量正常（NGT）组（均P<0.05）。在IVGTT中，除T2DM组呈低平台且无分泌峰值外，所有组的胰岛素分泌在2-4分钟达到峰值。TNGT组、TIGR组和TDM组的IP值高于NGT组、IGR组和T2DM组（均P<0.05）。TDM组的Ip/I0、AIR0'10'和AUCins-IVGTT值高于T2DM组，但低于TNGT组、TIGR组、NGR组和IGR组（均P<0.05）。与其他五组相比，T2DM组的Ip/I0、AIR0'10'和AUCins-IVGTT值显著降低（均P<0.05）。TNGT组的Ip/I0和AUCins-IVGTT值高于NGT组（均P<0.05）。
TDM患者的β细胞功能优于T2DM患者。第一相胰岛素分泌可作为鉴别TDM和T2DM的早期诊断标志物。
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