未经治疗的2型糖尿病患者血清皮质醇与胰岛素分泌及血浆醛固酮与胰岛素抵抗的相关性：一项横断面研究
Association of serum cortisol with insulin secretion and plasma aldosterone with insulin resistance in untreated type 2 diabetes: a cross-sectional study.
作者信息
Ohira Masahiro, Kawagoe Naoyuki, Kameyama Chisato, Kondou Yuko, Igarashi Madoka, Ueshiba Hajime
机构信息
Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
出版信息
Diabetol Metab Syndr. 2025 Apr 28;17(1):144. doi: 10.1186/s13098-025-01706-8.
BACKGROUND
Insulin secretion and resistance are key pathophysiological factors in type 2 diabetes. However, only 55% of patients achieve long-term blood glucose treatment goals, highlighting the need to clarify the pathophysiology of type 2 diabetes. While cortisol and aldosterone levels have been linked to insulin secretion and resistance in participants without type 2 diabetes, their role in patients with type 2 diabetes remains unclear. In this study, we aimed to investigate the relationships among insulin secretion, insulin resistance, and cortisol or aldosterone levels in patients with untreated type 2 diabetes.
METHODS
We retrospectively reviewed 121 patients with untreated type 2 diabetes mellitus. We analyzed the relationships between various clinical parameters, including adrenal hormones, and insulin secretion (homeostatic model assessment [HOMA2-%B]) or insulin resistance (HOMA2-IR). Multiple regression analysis was performed to identify parameters associated with HOMA2-%B or HOMA2-IR.
RESULTS
Spearman's rank correlation coefficient revealed that body weight (BW); body mass index (BMI); estimated glomerular filtration rate; and serum creatinine, uric acid, total cholesterol, high-density lipoprotein cholesterol (HDL-C), sodium, potassium, chloride, fasting blood glucose (FBG), glycated hemoglobin (HbA1c), serum C-peptide, and cortisol levels were significantly correlated with HOMA2-%B. Similarly, BW, BMI, aspartate transaminase levels, alanine transaminase (ALT) levels, triglyceride levels, HDL-C levels, FBG levels, serum C-peptide levels, renin activity, and plasma aldosterone concentration (PAC) were significantly correlated with HOMA2-IR. Multiple regression analysis revealed BMI, HbA1c levels, and cortisol levels as predictors of HOMA2-%B, whereas ALT levels and the PAC were predictors of HOMA2-IR.
CONCLUSION
Serum cortisol levels are associated with insulin secretion, and the PAC is associated with insulin resistance in patients with untreated type 2 diabetes. These findings suggest that aldosterone blockade may represent a potential therapeutic approach for reducing insulin resistance in patients with type 2 diabetes.
背景
胰岛素分泌和抵抗是2型糖尿病关键的病理生理因素。然而，只有55%的患者能实现长期血糖治疗目标，这凸显了阐明2型糖尿病病理生理学的必要性。虽然在无2型糖尿病的参与者中，皮质醇和醛固酮水平与胰岛素分泌和抵抗有关，但其在2型糖尿病患者中的作用仍不明确。在本研究中，我们旨在调查未经治疗的2型糖尿病患者胰岛素分泌、胰岛素抵抗与皮质醇或醛固酮水平之间的关系。
方法
我们回顾性分析了121例未经治疗的2型糖尿病患者。我们分析了包括肾上腺激素在内的各种临床参数与胰岛素分泌（稳态模型评估[HOMA2-%B]）或胰岛素抵抗（HOMA2-IR）之间的关系。进行多元回归分析以确定与HOMA2-%B或HOMA2-IR相关的参数。
结果
Spearman等级相关系数显示，体重（BW）、体重指数（BMI）、估计肾小球滤过率以及血清肌酐、尿酸、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、钠、钾、氯、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、血清C肽和皮质醇水平与HOMA2-%B显著相关。同样，BW、BMI、天冬氨酸转氨酶水平、丙氨酸转氨酶（ALT）水平、甘油三酯水平、HDL-C水平、FBG水平、血清C肽水平、肾素活性和血浆醛固酮浓度（PAC）与HOMA2-IR显著相关。多元回归分析显示，BMI、HbA1c水平和皮质醇水平是HOMA2-%B的预测指标，而ALT水平和PAC是HOMA2-IR的预测指标。
结论
在未经治疗的2型糖尿病患者中，血清皮质醇水平与胰岛素分泌有关，PAC与胰岛素抵抗有关。这些发现表明，醛固酮阻断可能是降低2型糖尿病患者胰岛素抵抗的一种潜在治疗方法。
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