CAJ | 학술논문

不同体重指数新诊断2型糖尿病患者胰岛素分泌和胰岛素抵抗状况调查
불동체중지수신진단2형당뇨병환자이도소분비화이도소저항상황조사
Features of insulin secretion and insulin resistance in newly diagnosed type 2 diabetes of different body mass indices

万方数据

中华医学杂志中華醫學雜誌 중화의학잡지
National Medical Journal of China
2009年 16期 1117-1121 ,共5页

安雅莉%高研%朱倩%宁光%贾伟平%黄勤%许雯%李成江%周智广%施秉银%单忠艳%陈璐璐%许樟荣%王姮%严励%钟惠菊%姬秋和%李红%薛元明%张木勋%谷卫%郭晓蕙%高蕾丽%洪洁%刘芳%邹大进%李延兵%张小英%李桢%郭辉%赵晓娟%吴汉妮%王玉珍%赵维纲%张少玲%吴静%张南雁%杨凤英%张云%周鑫荣%任跃忠%李光伟

안아리%고연%주천%저광%가위평%황근%허문%리성강%주지엄%시병은%단충염%진로로%허장영%왕항%엄려%종혜국%희추화%리홍%설원명%장목훈%곡위%곽효혜%고뢰려%홍길%류방%추대진%리연병%장소영%리정%곽휘%조효연%오한니%왕옥진%조유강%장소령%오정%장남안%양봉영%장운%주흠영%임약충%리광위

糖尿病,2型%肥胖%胰岛素抗药性%干预治疗糖尿病,2型%肥胖%胰島素抗藥性%榦預治療
당뇨병,2형%비반%이도소항약성%간예치료
Diabetes mellitns,type 2%Obesity%Insulin resistance%Intervention treatment

目的研究中国新诊断超重肥胖及非肥胖2型糖尿病患者胰岛素分泌功能(IS)、胰岛素抵抗状况(IR)的差别及降血糖药物干预对其影响,为临床治疗提供依据.方法对408例新诊断2型糖尿病患者和40例糖耐量正常人测量身高、体重;行口服葡萄糖耐量试验(OGTF)测定0、30、60、120 min血糖、胰岛素.糖尿病患者按空腹血糖(FBG)水平(DMI:FBG<6.9 mmol/L;DM2:6.9 mmol/L≤FBG<8.3 mmol/L;DM3;8.3 mmol/L≤FBG<9.7 mmol/L;DM4:FBG≥9.7 mmol/L)分为4组,每组内以体重指数(BMI)为界分为两个亚组(BMI<24、≥24),比较两亚组IR和IS.93例FBG>8.3 mmol/L者应用格列齐特(达美康)缓释片进行干预治疗1～3个月,血糖达标后重复OGTF并计算干预后的IR及IS,比较治疗前后的变化.结果 (1)BMI≥24亚组与正常组相比,存在高真胰岛素血症;(2)在每一组糖尿病患者中,BMI≥24亚组的胰岛素敏感性更差,但是IS都优于相应的BMI<24亚组;(3)降血糖药物干预后BMI<24组胰岛素敏感性变化优于BMI≥24组(-4.7±0.9比-5.5 4±1.4,P<0.05),而干预后IS的变化(△I30/△G30)BMI≥24组优于BMI<24组(1.37±0.16比0.50±0.19,P<0.05).结论新诊断2型糖尿病患者的胰岛素抵抗及胰岛素分泌功能随FBG升高而恶化,这种双重恶化的程度在血糖水平相似的超重肥胖及非肥胖患者明显不同;改善高糖毒性可使超重肥胖者胰岛素分泌功能显著恢复,而非肥胖患者胰岛素敏感性恢复更优.
목적 연구중국신진단초중비반급비비반2형당뇨병환자이도소분비공능(IS)、이도소저항상황(IR)적차별급강혈당약물간예대기영향,위림상치료제공의거.방법 대408례신진단2형당뇨병환자화40례당내량정상인측량신고、체중;행구복포도당내량시험(OGTF)측정0、30、60、120 min혈당、이도소.당뇨병환자안공복혈당(FBG)수평(DMI:FBG<6.9 mmol/L;DM2:6.9 mmol/L≤FBG<8.3 mmol/L;DM3;8.3 mmol/L≤FBG<9.7 mmol/L;DM4:FBG≥9.7 mmol/L)분위4조,매조내이체중지수(BMI)위계분위량개아조(BMI<24、≥24),비교량아조IR화IS.93례FBG>8.3 mmol/L자응용격렬제특(체미강)완석편진행간예치료1～3개월,혈당체표후중복OGTF병계산간예후적IR급IS,비교치료전후적변화.결과 (1)BMI≥24아조여정상조상비,존재고진이도소혈증;(2)재매일조당뇨병환자중,BMI≥24아조적이도소민감성경차,단시IS도우우상응적BMI<24아조;(3)강혈당약물간예후BMI<24조이도소민감성변화우우BMI≥24조(-4.7±0.9비-5.5 4±1.4,P<0.05),이간예후IS적변화(△I30/△G30)BMI≥24조우우BMI<24조(1.37±0.16비0.50±0.19,P<0.05).결론 신진단2형당뇨병환자적이도소저항급이도소분비공능수FBG승고이악화,저충쌍중악화적정도재혈당수평상사적초중비반급비비반환자명현불동;개선고당독성가사초중비반자이도소분비공능현저회복,이비비반환자이도소민감성회복경우.
Objective To investigate insulin secretion function and insulin resistance in Chinese newly diagnosed type 2 diabetes ( obese and non-obese patients) in order to provide evidence for clinical treatment. Methods A total of 408 newly diagnosed type 2 diabetes and 40 normal controls were recruited.Height and weight were measure& Insulin and glucose of 0, 30, 60 and 120 rain during oral glucose tolerance test were examined. The patients with fasting glucose level greater than 8.3 mmol/L were treated with gliclazide for 1-3 months. After normalization of plasma glucose levels for more than 2 weeks, this medication was withdrawn for 48 hours then OGTT repeated to assess IR and IS. Results The patients were divided into four groups based on fasting plasma glucose ( DMI : FBG <6. 9 mmol/L; DM2: 6. 9 mmol/L≤FBG < 8. 3 mmol/L; DM3 : 8. 3 mmol/L≤FBG < 9. 7 mmol/L; DM4 : FBG≥9. 7 mmol/L). Each group was further stratified to subgroups by cut-off point of BMI = 24 kg/m2. The insulin sensitivity and insulin secretion function were compared between the subgroups. (1) True insulin level in BMI≥24 (FBG < 6. 9mmol/L) subgroups were higher than controls ( 3.5±0. 5 vs 3. 2 ±0. 6 natural logarithm) ( P < 0. 05 ).(2) In BMI≥24 subgroups, the insulin sensitivity was even worse than BMI <24 groups, but the insulin secretion function was better at the same FBG level. (3) After intervention, the change of insulin sensitivity in Bmi <24 groups was better than BMI≥24 groups ( -4. 7±0. 9 vs -5.5±1.4 natural logarithm) (P <0. 05) ; but the change of insulin secretion function in BMI < 24 groups was worse. Conclusions ( 1 ) In newly diagnostic type 2 diabetes, insulin sensitivity and insulin secretion function decreased with the rising FBG, but they were different between the obese and non-ubese groups. (2) Insulin secretion function recovered better in the obese group when ameliorating glucose toxicity.