Gelding S V, Niththyananthan R, Chan S P, Skinner E, Robinson S, Gray I P, Mather H, Johnston D G
Unit of Metabolic Medicine, St Mary's Hospital Medical School, London, UK.
Clin Endocrinol (Oxf). 1994 Jan;40(1):55-62. doi: 10.1111/j.1365-2265.1994.tb02443.x.
Non-insulin-dependent diabetes is a heterogeneous disorder, the basis of which may differ in different ethnic groups. In order to investigate early metabolic abnormalities occurring during the development of the condition we assessed insulin secretion and insulin action in subjects predisposed to the later development of non-insulin-dependent diabetes from two different ethnic groups.
Subjects were studied on two separate occasions by an oral glucose tolerance test and a short insulin tolerance test.
Twenty-four glucose-tolerant first-degree relatives of patients with non-insulin-dependent diabetes (12 of European and 12 of Asian origin) were compared with 24 ethnically matched control subjects with no family history of diabetes.
Insulin, proinsulin, glucose and intermediary metabolites were measured during a 75-g oral glucose tolerance test. Insulin sensitivity was assessed using a 15-minute insulin tolerance test (0.05 units/kg).
Asian relatives compared to Asian controls had significantly higher fasting levels of immunoreactive insulin (83 +/- 17 vs 40 +/- 6 pmol/l, P < 0.05), which were not due to increased proinsulin. Blood glycerol concentrations were elevated (83 +/- 9 vs 51 +/- 4 mumol/l, P < 0.005), but fasting glucose and non-esterified fatty acid (NEFA) concentrations were similar. Relatives of European origin did not differ from their European controls in any of these measurements. The glucose response to oral glucose was similar in relatives and controls, irrespective of ethnic group. The insulin responses were non-significantly greater in relatives from both ethnic groups. Proinsulin levels were not significantly different. Asian relatives had higher circulating glycerol and NEFA levels after oral glucose than Asian controls, but these differences were not observed in the European group. Insulin sensitivity was reduced in the Asian relatives compared to their controls (183 +/- 7 vs 139 +/- 12 mumol/l/min, P < 0.01) but there was no difference in insulin sensitivity between the European relatives and European controls (167 +/- 11 vs 160 +/- 11 mumol/l/min).
First-degree relatives of non-insulin-dependent diabetic patients of Asian, but not of European, origin are insulin insensitive in terms of both glucose metabolism and lipolysis, and have true hyperinsulinaemia. This suggests that insulin insensitivity may be an early abnormality in the development of non-insulin-dependent diabetes in the Asian population.
非胰岛素依赖型糖尿病是一种异质性疾病，其发病基础在不同种族群体中可能有所不同。为了研究该疾病发展过程中早期出现的代谢异常，我们评估了来自两个不同种族群体、易患非胰岛素依赖型糖尿病的受试者的胰岛素分泌和胰岛素作用。
通过口服葡萄糖耐量试验和短期胰岛素耐量试验，在两个不同时间点对受试者进行研究。
将24名非胰岛素依赖型糖尿病患者的糖耐量正常的一级亲属（12名欧洲血统和12名亚洲血统）与24名无糖尿病家族史、种族匹配的对照受试者进行比较。
在75克口服葡萄糖耐量试验期间测量胰岛素、胰岛素原、葡萄糖和中间代谢产物。使用15分钟胰岛素耐量试验（0.05单位/千克）评估胰岛素敏感性。
与亚洲对照相比，亚洲亲属的空腹免疫反应性胰岛素水平显著更高（83±17对40±6皮摩尔/升，P<0.05），这并非由于胰岛素原增加所致。血甘油浓度升高（83±9对51±4微摩尔/升，P<0.005），但空腹血糖和非酯化脂肪酸（NEFA）浓度相似。欧洲血统的亲属在这些测量中的任何一项与欧洲对照均无差异。无论种族如何，亲属和对照对口服葡萄糖的血糖反应相似。两个种族群体亲属的胰岛素反应均无显著更大差异。胰岛素原水平无显著差异。亚洲亲属口服葡萄糖后循环甘油和NEFA水平高于亚洲对照，但在欧洲群体中未观察到这些差异。与对照相比，亚洲亲属的胰岛素敏感性降低（183±7对139±12微摩尔/升/分钟，P<0.01），但欧洲亲属与欧洲对照之间的胰岛素敏感性无差异（167±11对160±11微摩尔/升/分钟）。
亚洲血统而非欧洲血统的非胰岛素依赖型糖尿病患者的一级亲属在葡萄糖代谢和脂肪分解方面存在胰岛素不敏感，且存在真正的高胰岛素血症。这表明胰岛素不敏感可能是亚洲人群非胰岛素依赖型糖尿病发展过程中的早期异常。
