Shin C S, Lee H K, Koh C S, Kim Y I, Shin Y S, Yoo K Y, Paik H Y, Park Y S, Yang B G
Department of Internal Medicine, Seoul National University, Korea.
Diabetes Care. 1997 Dec;20(12):1842-6. doi: 10.2337/diacare.20.12.1842.
To determine the risk factors for the development of NIDDM in Yonchon County of Korea.
We studied 1,193 Korean nondiabetic subjects at baseline who participated in a 2-year follow-up study on diabetes in Yonchon County. A 75-g oral glucose tolerance test was performed 2 years after the baseline examination. Age, sex, and anthropometric and metabolic characteristics at baseline were analyzed simultaneously as potential predictors of conversion to NIDDM. We also designed a nested case-control study to determine the role of hyperinsulinemia and/or hyperproinsulinemia in the conversion to NIDDM in patients with newly developed diabetes and control subjects matched for age, sex, BMI, and waist-to-hip-ratio.
At 2 years, 67 subjects developed diabetes, as defined by World Health Organization criteria. The age-adjusted incidence was significantly higher in men (6.4%) than in women (3.0%), and the incidence increased as age increased in both sexes. Multiple logistic regression analysis revealed age, male sex, and fasting and 2-h glucose levels to be significant risk factors for the development of NIDDM, whereas waist-to-hip ratio and BMI were not. In a nested case-control study, baseline proinsulin but not insulin levels were significantly higher in subjects who progressed to NIDDM than in those who did not.
In the Korean population, beta-cell dysfunction, as measured by high proinsulin levels, seems to be associated with subsequent development of NIDDM, whereas regional and general obesity and fasting insulin levels, which may be a surrogate for insulin resistance, were not.
确定韩国延川郡非胰岛素依赖型糖尿病（NIDDM）发生的危险因素。
我们对1193名韩国非糖尿病受试者进行了基线研究，这些受试者参与了延川郡一项为期2年的糖尿病随访研究。在基线检查2年后进行了75克口服葡萄糖耐量试验。同时分析了基线时的年龄、性别、人体测量学和代谢特征，将其作为转化为NIDDM的潜在预测因素。我们还设计了一项巢式病例对照研究，以确定高胰岛素血症和/或高胰岛素原血症在新发生糖尿病患者和年龄、性别、体重指数（BMI）及腰臀比相匹配的对照受试者转化为NIDDM过程中的作用。
2年后，67名受试者按照世界卫生组织标准被诊断为糖尿病。年龄调整后的发病率男性（6.4%）显著高于女性（3.0%），且男女发病率均随年龄增加而上升。多因素逻辑回归分析显示，年龄、男性性别、空腹及2小时血糖水平是NIDDM发生的显著危险因素，而腰臀比和BMI则不是。在巢式病例对照研究中，进展为NIDDM的受试者基线胰岛素原水平显著高于未进展者，而胰岛素水平则无显著差异。
在韩国人群中，以高胰岛素原水平衡量的β细胞功能障碍似乎与随后NIDDM的发生有关，而区域性和全身性肥胖以及空腹胰岛素水平（可能是胰岛素抵抗的替代指标）则无关。
