Qi Ge-Yao, Wang Fei, Shi Yuan-Bo, Feng Juan, Xu Jin
Department of Internal Medicine, No. 32186 Unit Hospital of People's Liberation Army of China (PLA), Baoding, 071000, Hebei, China.
Department of Cardiology, No. 940 Hospital of Logistics Support Force of People's Liberation Army of China (PLA), Lanzhou, 730050, Gansu, China.
Acta Diabetol. 2025 Apr 1. doi: 10.1007/s00592-025-02503-5.
Metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) are increasingly prevalent metabolic disorders worldwide, with a complex bidirectional relationship between them. Currently, there is a lack of research on the trajectories of blood glucose and insulin concentration over time after eating in patients with MASLD and T2DM.
This clinical cohort included diagnosed T2DM patients in a large hospital over the past five years, was divided into an observation group (with MASLD) and a control group (without MASLD). The postprandial time trends of blood glucose and insulin concentration were analysed within two hours after eating. A strategy of backward iterative feature elimination combined with propensity score matching (PSM) was employed to screen for potential associated factors that might influence these trends.
In total, there were 521 in the observation group and 373 in the control group. In terms of blood glucose, the postprandial time-concentration trajectories for both groups shown a significant time main effect (F = 1145.567, P < 0.001), a significant group main effect (F = 15.340, P < 0.001), and a significant timegroup interaction effect (F = 2.873, P = 0.035); After matching all the factors, the timegroup interaction effect of blood glucose was not significant, but the differences from group main effect still existed. In terms of insulin, the postprandial time-concentration trajectories for both groups shown a significant time main effect (F = 309.429, P < 0.001), a significant group main effect (F = 6.319, P < 0.012), and a significant timegroup interaction effect (F = 20.057, P < 0.001), but the trajectories crossed; After matching 4 factors such as Smoking, Essential Hypertension (EH), Body Mass Index (BMI), Triglyceride (TG) and Ca, neither the group main effect nor the timegroup interaction effect on insulin was significant any more.
The postprandial trends of blood glucose and insulin concentration over time shown significant differences between T2DM patients with and without MASLD. IL-6 might be associated with the insulin resistance, while EH and Ca might be related to the islet β-cell function. Smoking and TG might participate in both of the above processes. The strategy of backward iterative with PSM had demonstrated a relatively satisfactory effect in feature screening.
代谢功能障碍相关脂肪性肝病（MASLD）和2型糖尿病（T2DM）是全球范围内日益普遍的代谢紊乱疾病，二者之间存在复杂的双向关系。目前，关于MASLD和T2DM患者进食后血糖和胰岛素浓度随时间变化的轨迹缺乏研究。
本临床队列纳入了过去五年内某大型医院确诊的T2DM患者，分为观察组（患有MASLD）和对照组（未患MASLD）。分析进食后两小时内血糖和胰岛素浓度的餐后时间趋势。采用向后迭代特征消除结合倾向得分匹配（PSM）策略筛选可能影响这些趋势的潜在相关因素。
观察组共521例，对照组共373例。血糖方面，两组的餐后时间-浓度轨迹均显示出显著的时间主效应（F = 1145.567，P < 0.001）、显著的组间主效应（F = 15.340，P < 0.001）和显著的时间组间交互效应（F = 2.873，P = 0.035）；匹配所有因素后，血糖的时间组间交互效应不显著，但组间主效应差异仍然存在。胰岛素方面，两组的餐后时间-浓度轨迹均显示出显著的时间主效应（F = 309.429，P < 0.001）、显著的组间主效应（F = 6.319，P < 0.012）和显著的时间组间交互效应（F = 20.057，P < 0.001），但轨迹交叉；匹配吸烟、原发性高血压（EH）、体重指数（BMI）、甘油三酯（TG）和钙等4个因素后，胰岛素的组间主效应和时间组间交互效应均不再显著。
有和没有MASLD的T2DM患者之间，血糖和胰岛素浓度随时间的餐后趋势存在显著差异。白细胞介素-6可能与胰岛素抵抗有关，而EH和钙可能与胰岛β细胞功能有关。吸烟和TG可能参与上述两个过程。PSM向后迭代策略在特征筛选中显示出相对满意的效果。
