1 小时和 2 小时餐后血浆葡萄糖浓度是西南美洲原住民 2 型糖尿病的可比预测指标。
One-hour and two-hour postload plasma glucose concentrations are comparable predictors of type 2 diabetes mellitus in Southwestern Native Americans.
机构信息
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 N. 16th Street, Phoenix, AZ, 85016, USA.
出版信息
Diabetologia. 2017 Sep;60(9):1704-1711. doi: 10.1007/s00125-017-4332-1. Epub 2017 Jun 29.
AIMS/HYPOTHESIS: Elevated 2-h plasma glucose concentration (2 h-PG) during a 75 g OGTT predict the development of type 2 diabetes mellitus. However, 1-h plasma glucose concentration (1 h-PG) is associated with insulin secretion and may be a better predictor of type 2 diabetes. We aimed to investigate the association between 1 h-PG and 2 h-PG using gold standard methods for measuring insulin secretion and action. We also compared 1 h-PG and 2 h-PG as predictors of type 2 diabetes mellitus.
METHODS
This analysis included adult volunteers without diabetes, predominantly Native Americans of Southwestern heritage, who were involved in a longitudinal epidemiological study from 1965 to 2007, with a baseline OGTT that included measurement of 1 h-PG. Group 1 (n = 716) underwent an IVGTT and hyperinsulinaemic-euglycaemic clamp for measurement of acute insulin response (AIR) and insulin-stimulated glucose disposal (M), respectively. Some members of Group 1 (n = 490 of 716) and members of a second, larger, group (Group 2; n = 1946) were followed-up to assess the development of type 2 diabetes (median 9.0 and 12.8 years follow-up, respectively).
RESULTS
Compared with 2 h-PG (r = -0.281), 1 h-PG (r = -0.384) was more closely associated with AIR, whereas, compared with 1 h-PG (r = -0.340), 2 h-PG (r = -0.408) was more closely associated with M. Measures of 1 h-PG and 2 h-PG had similar abilities to predict type 2 diabetes, which did not change when both were included in the model. A 1 h-PG cut-off of 9.3 mmol/l provided similar levels of sensitivity and specificity as a 2 h-PG cut-off of 7.8 mmol/l; the latter is used to define impaired glucose tolerance, a recognised predictor of type 2 diabetes mellitus.
CONCLUSIONS/INTERPRETATION: The 1 h-PG was associated with important physiological predictors of type 2 diabetes and was as effective as 2 h-PG for predicting type 2 diabetes mellitus. The 1 h-PG is, therefore, an alternative method of identifying individuals with an elevated risk of type 2 diabetes mellitus.
目的/假设：口服葡萄糖耐量试验（OGTT）中 2 小时血浆葡萄糖浓度（2 h-PG）升高可预测 2 型糖尿病的发生。然而，1 小时血浆葡萄糖浓度（1 h-PG）与胰岛素分泌有关，可能是 2 型糖尿病更好的预测指标。我们旨在使用测量胰岛素分泌和作用的金标准方法，研究 1 h-PG 和 2 h-PG 之间的关联。我们还比较了 1 h-PG 和 2 h-PG 作为 2 型糖尿病的预测指标。
方法
本分析纳入了无糖尿病的成年志愿者，主要是来自美国西南部的原住民，他们参与了一项从 1965 年到 2007 年的纵向流行病学研究，基线 OGTT 包括 1 h-PG 的测量。第 1 组（n=716）接受静脉葡萄糖耐量试验（IVGTT）和高胰岛素-正常血糖钳夹试验，分别测量急性胰岛素反应（AIR）和胰岛素刺激的葡萄糖处置（M）。第 1 组的一些成员（n=716 中的 490 名）和第二组（n=1946 名）的其他成员进行了随访，以评估 2 型糖尿病的发生（中位随访时间分别为 9.0 年和 12.8 年）。
结果
与 2 h-PG（r= -0.281）相比，1 h-PG（r= -0.384）与 AIR 的相关性更强，而与 1 h-PG（r= -0.340）相比，2 h-PG（r= -0.408）与 M 的相关性更强。1 h-PG 和 2 h-PG 的测量值都具有预测 2 型糖尿病的相似能力，当同时纳入模型时，这种能力并没有改变。1 h-PG 切点为 9.3 mmol/L 时，其敏感性和特异性与 2 h-PG 切点为 7.8 mmol/L 时相似；后者用于定义糖耐量受损，是 2 型糖尿病的一个公认预测指标。
结论/解释：1 h-PG 与 2 型糖尿病的重要生理预测指标相关，与 2 h-PG 一样，可有效预测 2 型糖尿病。因此，1 h-PG 是识别 2 型糖尿病高危人群的一种替代方法。
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