Lind L, Lithell H, Pollare T, Ljunghall S
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Acta Diabetol. 1994 Apr;31(1):26-30. doi: 10.1007/BF00580756.
Both insulin secretion and sensitivity have been claimed to be the main characteristics in the determination of future deterioration in glucose tolerance. In this cross-sectional study insulin secretion and insulin sensiturity were determined in 228 subjects with varying degrees of glucose tolerance. Insulin secretion was measured in an intravenous glucose tolerance test (IVGTT) and insulin sensitivity by the hyperinsulinaemic euglycaemic clamp test. Both the early insulin response in the IVGTT (increment) and the glucose disposal rate in the clamp test (M-value) were found to be related hyperbolically to fasting glucose (r = -0.63 and -0.66, respectively; both P < 0.0001) and in a second-order polynomial manner to the glucose disappearance rate (k-value) in the IVGTT (r = 0.53 and 0.48, respectively; both P < 0.0001). Multiple regression analysis showed the insulin increment in the IVGTT and the M-value in the clamp test to be equally important determinants of glucose tolerance, together explaining about 50% of the variation in fasting glucose and the k-value in the IVGTT. In conclusion, in this cross-sectional study insulin secretion and sensitivity studied over a broad range of glucose tolerance were found to be of almost equal importance in the determination of glucose tolerance. However, low levels of insulin increment in the IVGTT were more often associated with glucose intolerance than was a low insulin sensitivity.
胰岛素分泌和敏感性均被认为是决定未来糖耐量恶化的主要特征。在这项横断面研究中，对228名糖耐量程度不同的受试者测定了胰岛素分泌和胰岛素敏感性。通过静脉葡萄糖耐量试验（IVGTT）测量胰岛素分泌，通过高胰岛素正常血糖钳夹试验测量胰岛素敏感性。发现IVGTT中的早期胰岛素反应（增量）和钳夹试验中的葡萄糖处置率（M值）与空腹血糖呈双曲线相关（分别为r = -0.63和-0.66；均P < 0.0001），并且与IVGTT中的葡萄糖消失率（k值）呈二阶多项式关系（分别为r = 0.53和0.48；均P < 0.0001）。多元回归分析表明，IVGTT中的胰岛素增量和钳夹试验中的M值是糖耐量的同等重要决定因素，共同解释了空腹血糖和IVGTT中k值约50%的变异。总之，在这项横断面研究中，发现在广泛的糖耐量范围内研究的胰岛素分泌和敏感性在决定糖耐量方面几乎同等重要。然而，IVGTT中胰岛素增量水平低比胰岛素敏感性低更常与葡萄糖不耐受相关。
