30岁以上正常糖耐量居民胰岛素敏感性及相关因素分析

An analysis for insulin sensitivity and associated factors in people with normal glucose tolerance aged over 30 years

目的分析中老年人群正常糖耐量者血糖水平与胰岛素敏感性的相互关系。方法在流行病学调查中选择上海市杨浦区部分街道2098例30岁以上居民,根据口服葡萄糖耐量试验中空腹血糖值和2h血糖值,分别诊断为正常糖耐量、糖耐量低减、空腹血糖受损、糖耐量低减合并空腹血糖受损和糖尿病。在正常糖耐量范围者按年龄分成5组,按空腹和2h血糖值分成6组,观察采用稳态模式胰岛素抵抗指数(HOMAIR),并对各组的年龄、血糖与胰岛素抵抗指标进行统计学分析。结果在正常糖耐量者中60～69年龄组空腹血糖值[(5.2±0.5)mmol/L]较50～59年龄组[(5.1±0.4)mmol/L]高(P<0.05),50～59年龄组空腹血糖值较40～49年龄组高(P<0.05);各组空腹胰岛素值、胰岛素敏感性有升高趋势,但无统计学意义(P>0.05);而平均空腹血糖值>5.0mmol/L组较空腹血糖<5.0mmol/L组胰岛素敏感性升高;胰岛素敏感性与腰围、糖化血红蛋白、体重指数呈显著正相关。结论中老年正常糖耐量人群随着年龄的增长,空腹血糖可能增高,空腹血糖≥5.0mmol/L可能存在胰岛素敏感性下降。

Objectives To investigate the relationship between fasting plasma glucose (FPG) levels and insulin sensitivity in middle-aged and the elderly people with normal glucose tolerance.MethodsTotally, a community-based population of 2 098 residents aged above 30 years were selected from Yangpu District, Shanghai, and tested with oral glucose tolerance test (OGTT) and divided, according to fasting and 2-hour postprandial glucose levels (2 hPG), into five groups, i.e., normal glucose tolerance (NGT), impaired glucose tolerance (IGT), impaired fasting glucose, both IGT and IFG impaired (IFG/IGT), and diabetes (DM). The subjects in NGT group were further divided into five subgroups by age, and six subgroups by FPG and 2 hPG, respectively. Statistical analysis was performed by their age, level of blood sugar and HOMA-IR in varied groups and subgroups.Results For people in NGT group, level of FPG was higher in subjects aged 60~69 years than that in those aged 50~59, (5.2±0.5) mmol/L vs (5.1±0.4) mmol/L (P<0.05), while level of FPG was highe in subjects aged 50~59 than that in those aged 40~49 years (P<0.05). HOMA-IR and fasting insulin level had a tendency to increase with age, but without statistical significance (P>0.05). Insulin sensitivity was lower in subjects with an average FPG>5.0 mmol/L than that in those with PGF <5.0 mmol/L. HOMA-IR positively correlated well with waist circumference, level of glycosylated hemoglobin A1c (HbA1c) and body mass index (BMI).Conclusions In middle-aged and the elderly people with NGT, FPG increased with age and insulin sensitivity could decrease in those with FPG higher than 5.0 mmol/L.