单纯空腹血糖受损和单纯空腹高血糖型糖尿病的代谢特征

The metabolic characteristics of isolated impaired fasting glucose and fasting hyperglycemia

目的评估初发的单纯空腹血糖受损(iIFG)和单纯空腹高血糖型糖尿病(IFH)患者的胰岛素分泌及胰岛素敏感性特征,进一步探讨进展为 IFH 的相关因素。方法 2004-2005年瑞金医院内分泌科门诊初诊病人,隔夜空腹10h 后行口服葡萄糖耐量试验,其中同时行胰岛素释放试验1852例。其中糖耐量正常(NGT)557例;iIFG 221例;IFH 81例。比较各组的代谢指标及胰岛素分泌和胰岛素敏感性指数。结果对1852例接受者操作特征曲线(ROC)分析确定的糖耐量异常(除外糖尿病)发生的最佳空腹血糖切点为5.590mmol/L,2型糖尿病发生的最佳空腹血糖切点为6.695mmol/L。从 NGT→iIFG→IFH,早期相胰岛素分泌和胰岛素敏感性指数均逐渐降低。结论初发的iIFG 和 IFH 均有显著的早期相胰岛素分泌缺陷和胰岛素敏感性降低。β细胞胰岛素分泌缺陷和胰岛素抵抗均是从 NGT 向 iIFG 向 IFH 的进展过程中的重要因素。

Objective To evaluate the metabolic characteristics of insulin secretion and insulin sensitivity in isolated impaired fasting glucose （iIFG） and isolated fasting hyperglycemia （IFH） and to clarify the factors responsible for the development of IFH. Methods Receiver operating characteristic curve （ROC） analysis was conducted in 1852 subjects. Three groups were classified according to a 75 g oral glucose tolerance test （OGTT） ： （ 1 ） normal glucose tolerance （NGT） , n = 557 ; （ 2 ） iIFG, n = 221 ; （ 3 ） IFH, n = 81. The three groups were compared with insulin secretion （insulinogenic index） and insulin sensitivity （ insulin sensitivity index）. Results Using ROC analysis, the optimal cut point of fasting plasma glucose （FPG） related to diabetes diagnosis with OGTT was 6. 695 mmoL/L and the optimal cut point of FPG related to impaired glucose to lerance （IGT） diagnosis with OGTT was 5. 590 mmoL/L. From NGT to iIFG and IFH in these subjects, the insulinogenic index and insulin sensitivity index showed gradual decrease. Conclusion Subjects with iIFG and IFH exhibit distinctly impaired early-phase insulin secretion and insulin sensitivity, indicating that both reduced insulin secretion and insulin resistance are the determinants of deterioration from NGT to iIFG and IFH.