Department of Pediatrics, Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Adolesc Health. 2017 Dec;61(6):703-708. doi: 10.1016/j.jadohealth.2017.06.007. Epub 2017 Sep 19.
The progression of β-cell function in newly diagnosed adolescents with type 2 diabetes mellitus (T2DM) is not well documented. We hypothesized that at the time of diagnosis with T2DM, adolescents would have impaired β-cell function as demonstrated by the disposition index (calculated as: insulin secretion adjusted for insulin sensitivity), and this would be followed by a rapid decline of function despite standard medical management.
Thirty-nine adolescents with recently diagnosed T2DM and 32 obese adolescent controls with normal glucose tolerance had acute insulin response to glucose, homeostatic model assessment of insulin resistance, and disposition index measured serially over 2 years.
In the adolescent T2DM group, fasting glucose increased over 2 years (p = .04), while DI was impaired at baseline and showed an overall relative decline of 25% per year. The mean Hemoglobin A remained below 8% (64 mmol/mol). Differences were observed between the T2DM and control adolescents in the way DI changed over time (p = .02).
β-cell function in adolescents with recently diagnosed T2DM was impaired with no improvement of β-cell function over the 2 years of study despite stable Hemoglobin A, body mass index markers of insulin sensitivity, and standard treatment of hyperglycemia.
新诊断为 2 型糖尿病（T2DM）的青少年β细胞功能的进展情况尚未得到充分记录。我们假设，在诊断为 T2DM 时，青少年的β细胞功能受损，表现在胰岛素分泌对胰岛素敏感性的调整后的离散指数（disposition index，DI）上，尽管进行了标准的医学治疗，但β细胞功能仍会迅速下降。
对 39 名新诊断为 T2DM 的青少年和 32 名糖耐量正常的肥胖青少年进行了急性血糖胰岛素反应、稳态模型评估的胰岛素抵抗和 DI 的连续 2 年检测。
在青少年 T2DM 组中，空腹血糖在 2 年内升高（p=0.04），而 DI 在基线时受损，并以每年 25%的相对下降率持续下降。平均糖化血红蛋白仍低于 8%（64mmol/mol）。在 DI 随时间变化的方式上，T2DM 组和对照组青少年之间存在差异（p=0.02）。
尽管糖化血红蛋白、胰岛素敏感性的体重指数标志物和高血糖的标准治疗保持稳定，但新诊断为 T2DM 的青少年的β细胞功能受损，在 2 年的研究期间β细胞功能没有改善。
