Lillioja S, Mott D M, Spraul M, Ferraro R, Foley J E, Ravussin E, Knowler W C, Bennett P H, Bogardus C
Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Ariz. 85016.
N Engl J Med. 1993 Dec 30;329(27):1988-92. doi: 10.1056/NEJM199312303292703.
The relative roles of obesity, insulin resistance, insulin secretory dysfunction, and excess hepatic glucose production in the development of non-insulin-dependent diabetes mellitus (NIDDM) are controversial. We conducted a prospective study to determine which of these factors predicted the development of the disease in a group of Pima Indians.
A body-composition assessment, oral and intravenous glucose-tolerance tests, and a hyperinsulinemic--euglycemic clamp study were performed in 200 non-diabetic Pima Indians (87 women and 113 men; mean [+/- SD] age, 26 +/- 6 years). The subjects were followed yearly thereafter for an average of 5.3 years.
Diabetes developed in 38 subjects during follow-up. Obesity, insulin resistance (independent of obesity), and low acute plasma insulin response to intravenous glucose (with the degree of obesity and insulin resistance taken into account) were predictors of NIDDM: The six-year cumulative incidence of NIDDM was 39 percent in persons with values below the median for both insulin action and acute insulin response, 27 percent in those with values below the median for insulin action but above that for acute insulin response, 13 percent in those with values above the median for insulin action and below that for acute insulin response, and 0 in those with values originally above the median for both characteristics.
Insulin resistance is a major risk factor for the development of NIDDM: A low acute insulin response to glucose is an additional but weaker risk factor.
肥胖、胰岛素抵抗、胰岛素分泌功能障碍以及肝脏葡萄糖生成过多在非胰岛素依赖型糖尿病（NIDDM）发病过程中的相对作用存在争议。我们进行了一项前瞻性研究，以确定在一组皮马印第安人中，这些因素中哪些可预测该疾病的发生。
对200名非糖尿病皮马印第安人（87名女性和113名男性；平均[±标准差]年龄为26±6岁）进行了身体成分评估、口服和静脉葡萄糖耐量试验以及高胰岛素-正常血糖钳夹研究。此后每年对受试者进行随访，平均随访5.3年。
随访期间有38名受试者患糖尿病。肥胖、胰岛素抵抗（独立于肥胖）以及静脉注射葡萄糖后急性血浆胰岛素反应低下（考虑到肥胖程度和胰岛素抵抗）是NIDDM的预测因素：胰岛素作用和急性胰岛素反应值均低于中位数的人群中，NIDDM的六年累积发病率为39%；胰岛素作用值低于中位数但急性胰岛素反应值高于中位数的人群中为27%；胰岛素作用值高于中位数但急性胰岛素反应值低于中位数的人群中为13%；最初这两个特征值均高于中位数的人群中为0。
胰岛素抵抗是NIDDM发病的主要危险因素：葡萄糖急性胰岛素反应低下是另一个较弱的危险因素。
