Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
National Institutes of Health Clinical Center, Bethesda, Maryland.
J Clin Endocrinol Metab. 2019 Jan 1;104(1):181-192. doi: 10.1210/jc.2018-01032.
Postprandial hyperinsulinemia might be an important cardiometabolic risk determinant in black compared with white women. However, the contributions of insulin clearance and β-cell function to racial differences in postprandial insulin response are unknown.
To compare, by race and menopause, early insulin response to oral and intravenous glucose and to measure postprandial intact glucagon-like peptide 1 (GLP-1) concentrations, insulin clearance, and β-cell function.
119 federally employed women without diabetes [87 premenopausal (52 black, 35 white) and 32 postmenopausal (19 black, 13 white)] underwent an oral glucose tolerance test, insulin-modified frequently sampled intravenous glucose test (IM-FSIGT), and mixed meal tolerance test (MMTT).
Early insulin response was measured as follows: (i) insulinogenic index (oral glucose tolerance test); (ii) acute insulin response to glucose (IM-FSIGT); and (iii) ratio of incremental insulin/glucose area under the curve in the first 30 minutes of the MMTT. Insulin clearance was assessed during the IM-FSIGT and MMTT. During the MMTT, intact GLP-1 was measured and β-cell function assessed using the insulin secretion rate and β-cell responsivity indexes.
Black pre-menopausal and postmenopausal women had a greater insulin response and lower insulin clearance and greater dynamic β-cell responsivity (P ≤ 0.05 for all). No differences were found in the total insulin secretion rates or intact GLP-1 concentrations.
Greater postprandial hyperinsulinemia in black pre-menopausal and postmenopausal women was associated with lower hepatic insulin clearance and heightened β-cell capacity to rapid changes in glucose, but not to higher insulin secretion. The relationship of increased β-cell secretory capacity, reduced insulin clearance, and ambient hyperinsulinemia to the development of cardiometabolic disease requires further investigation.
与白人女性相比，餐后高胰岛素血症可能是黑人女性重要的代谢心血管风险决定因素。然而，胰岛素清除率和β细胞功能对餐后胰岛素反应的种族差异的贡献尚不清楚。
按种族和绝经情况比较口服和静脉葡萄糖后早期胰岛素反应，并测量餐后完整胰高血糖素样肽 1（GLP-1）浓度、胰岛素清除率和β细胞功能。
119 名无糖尿病的联邦雇员女性[87 名绝经前（52 名黑人，35 名白人）和 32 名绝经后（19 名黑人，13 名白人）]接受口服葡萄糖耐量试验、胰岛素改良频繁采样静脉葡萄糖试验（IM-FSIGT）和混合餐耐量试验（MMTT）。
早期胰岛素反应的测量如下：（i）口服葡萄糖耐量试验的胰岛素生成指数；（ii）IM-FSIGT 的急性胰岛素反应；和（iii）MMTT 前 30 分钟内增量胰岛素/血糖曲线下面积的比值。在 IM-FSIGT 和 MMTT 期间评估胰岛素清除率。在 MMTT 期间，测量完整 GLP-1 并使用胰岛素分泌率和β细胞反应性指数评估β细胞功能。
黑人绝经前和绝经后女性的胰岛素反应更大，胰岛素清除率更低，β细胞快速反应能力更强（所有 P 值均≤0.05）。总胰岛素分泌率或完整 GLP-1 浓度没有差异。
黑人绝经前和绝经后女性餐后高胰岛素血症增加与肝胰岛素清除率降低和β细胞快速适应葡萄糖变化的能力增强有关，但与更高的胰岛素分泌无关。增加的β细胞分泌能力、降低的胰岛素清除率和环境中的高胰岛素血症与代谢心血管疾病的发展之间的关系需要进一步研究。
