Nijpels G, Popp-Snijders C, Kostense P J, Bouter L M, Heine R J
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, Netherlands.
Diabetologia. 1996 Jan;39(1):113-8. doi: 10.1007/BF00400421.
The aims of the present study were to observe the natural history of impaired glucose tolerance and to identify predictors for development of non-insulin-dependent diabetes mellitus (NIDDM). A survey of glucose tolerance was conducted in subjects aged 50-74 years, randomly selected from the registry of the middle-sized town of Hoorn in the Netherlands. Based on the mean values of two oral glucose tolerance tests subjects were classified in categories of glucose tolerance according to the World Health Organization criteria. All subjects with impaired glucose tolerance (n = 224) were invited to participate in the present study, in which 70% (n = 158) were subsequently enrolled. During follow-up subjects underwent a repeated paired oral glucose tolerance test. The mean follow-up time was 24 months (range 12-36 months). The cumulative incidence of NIDDM was 28.5% (95% confidence interval 15-42%). Age, sex, and anthropometric and metabolic characteristics at baseline were analysed simultaneously as potential predictors of conversion to NIDDM using multiple logistic regression. The initial 2-h post-load plasma glucose levels and the fasting proinsulin levels were significantly (p < 0.05) related to the incidence of NIDDM. Anthropometric characteristics, the 2-h post-load specific insulin levels and the fasting proinsulin/fasting insulin ratio were not related to the incidence of NIDDM. These results suggest that beta-cell dysfunction rather than insulin resistance plays the most important role in the future development of diabetes in a high-risk Caucasian population.
本研究的目的是观察糖耐量受损的自然病程，并确定非胰岛素依赖型糖尿病（NIDDM）发生的预测因素。对从荷兰霍伦中型城镇登记处随机选取的50 - 74岁受试者进行了糖耐量调查。根据两次口服糖耐量试验的平均值，按照世界卫生组织标准将受试者分为糖耐量类别。所有糖耐量受损的受试者（n = 224）被邀请参加本研究，其中70%（n = 158）随后被纳入。在随访期间，受试者接受了重复的配对口服糖耐量试验。平均随访时间为24个月（范围12 - 36个月）。NIDDM的累积发病率为28.5%（95%置信区间15 - 42%）。使用多因素逻辑回归同时分析基线时的年龄、性别、人体测量和代谢特征作为转化为NIDDM的潜在预测因素。初始负荷后2小时血浆葡萄糖水平和空腹胰岛素原水平与NIDDM的发病率显著相关（p < 0.05）。人体测量特征、负荷后2小时特异性胰岛素水平和空腹胰岛素原/空腹胰岛素比值与NIDDM的发病率无关。这些结果表明，在高危白种人群中，β细胞功能障碍而非胰岛素抵抗在糖尿病的未来发展中起最重要作用。
