成年非洲人群新发2型糖尿病中的明显胰岛素缺乏

Apparent Insulin Deficiency in an Adult African Population With New-Onset Type 2 Diabetes.

作者信息

Kibirige Davis, Sekitoleko Isaac, Balungi Priscilla, Lumu William, Nyirenda Moffat J

机构信息

Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.

Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

出版信息

Front Clin Diabetes Healthc. 2022 Jul 28;3:944483. doi: 10.3389/fcdhc.2022.944483. eCollection 2022.

DOI:10.3389/fcdhc.2022.944483

PMID:36992725

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10012075/

Abstract

UNLABELLED

Identifying patients with new-onset type 2 diabetes who have insulin deficiency can aid in timely insulin replacement therapy. In this study, we measured fasting C-peptide concentration to assess endogenous insulin secretion and determine the prevalence and characteristics of patients with insulin deficiency in adult Ugandan patients with confirmed type 2 diabetes at presentation.

METHODS

Adult patients with new-onset diabetes were recruited from seven tertiary hospitals in Uganda. Participants who were positive for the three islet autoantibodies were excluded. Fasting C-peptide concentrations were measured in 494 adult patients, and insulin deficiency was defined as a fasting C-peptide concentration <0.76 ng/ml. The socio-demographic, clinical, and metabolic characteristics of participants with and without insulin deficiency were compared. Multivariate analysis was performed to identify independent predictors of insulin deficiency.

RESULTS

The median (IQR) age, glycated haemoglobin (HbA1c), and fasting C-peptide of the participants was 48 (39-58) years,10.4 (7.7-12.5) % or 90 (61-113) mmol/mol, and 1.4 (0.8-2.1) ng/ml, respectively. Insulin deficiency was present in 108 (21.9%) participants. Participants with confirmed insulin deficiency were more likely to be male (53.7% 40.4%, p=0.01), and had a lower body mass index or BMI [p<0.001], were less likely to be hypertensive [p=0.03], had reduced levels of triglycerides, uric acid, and leptin concentrations [p<0.001]), but higher HbA1c concentration (p=0.004). On multivariate analysis, BMI (AOR 0.89, 95% CI 0.85-0.94, p<0.001), non-HDLC (AOR 0.77, 95% CI 0.61-0.97, p=0.026), and HbA1c concentrations (AOR 1.08, 95% CI 1.00-1.17, p=0.049) were independent predictors of insulin deficiency.

CONCLUSION

Insulin deficiency was prevalent in this population, occurring in about 1 in every 5 patients. Participants with insulin deficiency were more likely to have high HbA1c and fewer markers of adiposity and metabolic syndrome. These features should increase suspicion of insulin deficiency and guide targeted testing and insulin replacement therapy.

摘要

未标注

识别出患有胰岛素缺乏的新发2型糖尿病患者有助于及时进行胰岛素替代治疗。在本研究中，我们测量了空腹C肽浓度，以评估内源性胰岛素分泌，并确定乌干达成年2型糖尿病确诊患者中胰岛素缺乏患者的患病率及特征。

方法

从乌干达的7家三级医院招募新发糖尿病成年患者。排除三种胰岛自身抗体呈阳性的参与者。对494名成年患者测量空腹C肽浓度，胰岛素缺乏定义为空腹C肽浓度<0.76 ng/ml。比较有和没有胰岛素缺乏的参与者的社会人口统计学、临床和代谢特征。进行多变量分析以确定胰岛素缺乏的独立预测因素。

结果

参与者的年龄中位数（四分位间距）、糖化血红蛋白（HbA1c）和空腹C肽分别为48（39 - 58）岁、10.4（7.7 - 12.5）%或90（61 - 113）mmol/mol以及1.4（0.8 - 2.1）ng/ml。108名（21.9%）参与者存在胰岛素缺乏。确诊为胰岛素缺乏的参与者更可能为男性（53.7%对40.4%，p = 0.01），且体重指数（BMI）较低[p<0.001]，患高血压的可能性较小[p = 0.03]，甘油三酯、尿酸和瘦素浓度水平较低[p<0.001]，但HbA1c浓度较高（p = 0.004）。多变量分析显示，BMI（比值比[AOR]0.89，95%置信区间[CI]0.85 - 0.94，p<0.001）、非高密度脂蛋白胆固醇（non-HDLC）（AOR 0.77，95% CI 0.61 - 0.97，p = 0.026）和HbA1c浓度（AOR 1.08，95% CI 1.00 - 1.17，p = 0.049）是胰岛素缺乏的独立预测因素。