Haffner S M, Bowsher R R, Mykkänen L, Hazuda H P, Mitchell B D, Valdez R A, Gingerich R, Monterossa A, Stern M P
Division of Clinical Epidemiology, University of Texas Health Science Center, San Antonio 78284-7873.
Diabetes. 1994 Dec;43(12):1490-3. doi: 10.2337/diab.43.12.1490.
Hyperinsulinemia and insulin resistance have been implicated as risk factors for the development of non-insulin-dependent diabetes mellitus (NIDDM). Recent data suggest that proinsulin may comprise a large proportion of immunoreactive insulin in subjects with NIDDM and possibly in those with impaired glucose tolerance (IGT) as well. Increased proinsulin concentrations are thought to be an early indicator of a failing pancreas. We examined proinsulin, insulin (using an assay that does not display appreciable cross-reactivity with proinsulin), and the fasting proinsulin:insulin ratio in 206 nondiabetic Mexican-American (a high-risk population for NIDDM) and 123 nondiabetic non-Hispanic white (a low-risk population for NIDDM) participants in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Mexican-Americans had significantly higher fasting and 2-h proinsulin and insulin levels but similar fasting proinsulin:insulin ratios compared with non-Hispanic whites. After statistical adjustment for age, body mass index, waist-to-hip ratio, and glucose tolerance status, Mexican-Americans continued to have higher fasting and 2-h insulin and fasting and 2-h proinsulin concentrations but similar proinsulin:insulin ratios compared with non-Hispanic whites. The fasting proinsulin:insulin ratio was higher in 85 subjects with NIDDM compared with subjects with IGT or normal glucose tolerance (0.31, 0.09, and 0.07, respectively). Thus, nondiabetic subjects from a high-risk population for NIDDM are hyperinsulinemic (using an assay that does not cross-react with proinsulin) and, further, do not secrete more proinsulin relative to insulin itself than do nondiabetic subjects from a low-risk population.
高胰岛素血症和胰岛素抵抗被认为是非胰岛素依赖型糖尿病（NIDDM）发生发展的危险因素。近期数据表明，在NIDDM患者中，胰岛素原可能占免疫反应性胰岛素的很大一部分，在糖耐量受损（IGT）患者中可能也是如此。胰岛素原浓度升高被认为是胰腺功能衰退的早期指标。在圣安东尼奥心脏研究中，我们检测了206名非糖尿病墨西哥裔美国人（NIDDM的高危人群）和123名非糖尿病非西班牙裔白人（NIDDM的低危人群）参与者的胰岛素原、胰岛素（使用与胰岛素原无明显交叉反应的检测方法）以及空腹胰岛素原：胰岛素比值。该研究是一项基于人群的糖尿病和心血管疾病研究。与非西班牙裔白人相比，墨西哥裔美国人的空腹和2小时胰岛素原及胰岛素水平显著更高，但空腹胰岛素原：胰岛素比值相似。在对年龄、体重指数、腰臀比和糖耐量状态进行统计调整后，与非西班牙裔白人相比，墨西哥裔美国人的空腹和2小时胰岛素以及空腹和2小时胰岛素原浓度仍然更高，但胰岛素原：胰岛素比值相似。与IGT或糖耐量正常的受试者相比，85名NIDDM患者的空腹胰岛素原：胰岛素比值更高（分别为0.31、0.09和0.07）。因此，来自NIDDM高危人群的非糖尿病受试者存在高胰岛素血症（使用与胰岛素原无交叉反应的检测方法），而且，相对于胰岛素本身，他们分泌的胰岛素原并不比来自低危人群的非糖尿病受试者更多。
