Eriksson K F, Lindgärde F
Department of Endocrinology, Lund University, University Hospital, Malmö, Sweden.
Diabetologia. 1996 May;39(5):573-9. doi: 10.1007/BF00403304.
In a prospective population-based study of middle-aged Caucasian men, performed in Malmö, Sweden, specifically designed to evaluate physical fitness, early and late insulin response as predictors of non-insulin-dependent diabetes mellitus (NIDDM), 4,637 non-diabetic men underwent oral glucose tolerance tests at the ages of 48 and 54 years. At the baseline examination, physical fitness was measured in terms of lung vital capacity and oxygen uptake during ergometry; early insulin response in terms of the 40-min insulin increment during an oral glucose tolerance test (a correlate of acute insulin response to an intravenous glucose tolerance test), and late insulin response were measured in terms of the 2-h insulin value during the oral glucose tolerance test (a correlate of glucose disposal during euglycaemic clamp testing). Of the subjects studied 116 developed NIDDM (0.4% annually), and when compared with non-diabetic men at baseline, they were found to have an 11% higher mean body mass index (p < 0.001), a higher frequency of family history of diabetes (31 vs 18%, p < 0.001), 16% lower mean physical activity index (p < 0.05), 16% lower mean estimated maximal oxygen uptake (p < 0.001), 10% lower mean vital capacity (p < 0.001), 26% lower 40-min to total insulin response ratio (p < 0.001), and a 2.7 times higher mean 2-h insulin value during an oral glucose tolerance test (p < 0.001). Regression analysis (using Cox's proportional hazards model) showed both low vital capacity, and impaired early insulin response but late hyperinsulinaemia to be independent predictors of NIDDM, in addition to body mass index and fasting blood glucose level (p = 0.05-0.0001). Among subjects with impaired glucose tolerance at baseline (44 of 278 developed NIDDM), fasting glucose level alone predicted diabetes in this model. The findings suggest that in this age group in a Caucasian population, not only does insulin resistance precede glucose intolerance and NIDDM, but also loss of early insulin response indicating impaired beta-cell function to be an early feature of the process culminating in diabetes. As both physical fitness [which correlates inversely with late insulin response (r= -0.42, p < 0.0001)], and the level of physical activity were shown to correlate with diabetes development in this large series, measures to correct these adverse features should be included in future strategies for preventing NIDDM.
在瑞典马尔默进行的一项针对中年白种男性的前瞻性人群研究中，该研究专门设计用于评估体能、早期和晚期胰岛素反应作为非胰岛素依赖型糖尿病（NIDDM）的预测指标，4637名非糖尿病男性在48岁和54岁时接受了口服葡萄糖耐量试验。在基线检查时，通过肺肺活量和运动试验中的摄氧量来测量体能；通过口服葡萄糖耐量试验期间40分钟胰岛素增加值（与静脉葡萄糖耐量试验的急性胰岛素反应相关）来测量早期胰岛素反应，通过口服葡萄糖耐量试验期间2小时胰岛素值（与正常血糖钳夹试验期间的葡萄糖处置相关）来测量晚期胰岛素反应。在所研究的受试者中，116人患了NIDDM（年发病率0.4%），与基线时的非糖尿病男性相比，发现他们的平均体重指数高11%（p<0.001），糖尿病家族史频率更高（31%对18%，p<0.001），平均体力活动指数低16%（p<0.05），平均估计最大摄氧量低16%（p<0.001），平均肺活量低10%（p<0.001），40分钟至总胰岛素反应比值低26%（p<0.001），口服葡萄糖耐量试验期间平均2小时胰岛素值高2.7倍（p<0.001）。回归分析（使用Cox比例风险模型）显示，除了体重指数和空腹血糖水平外，低肺活量、早期胰岛素反应受损但晚期高胰岛素血症也是NIDDM的独立预测指标（p=0.05 - 0.0001）。在基线时糖耐量受损的受试者中（278人中有44人患了NIDDM），在该模型中仅空腹血糖水平可预测糖尿病。研究结果表明，在白种人群的这个年龄组中，不仅胰岛素抵抗先于葡萄糖不耐受和NIDDM出现，而且早期胰岛素反应丧失表明β细胞功能受损是导致糖尿病这一过程的早期特征。由于在这个大样本系列中显示体能[与晚期胰岛素反应呈负相关（r = -0.42，p<0.0001）]以及体力活动水平均与糖尿病发生相关，纠正这些不良特征的措施应纳入未来预防NIDDM的策略中。
