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

Features of insulin secretion and insulin resistance in newly diagnosed type 2 diabetes of different body mass indices

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（OGTT）测定0、30、60、120min血糖、胰岛素。糖尿病患者按空腹血糖（FBG）水平（DMI：FBG〈6．9mmol／L；DM2：6．9mmol／L≤FBG〈8．3mmol／L；DM3：8．3mmol／L≤FBG〈9．7mmol／L；DM4：FBG≥9．7mmol／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〉8．3mmol／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OGTT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±1．4，P〈0．05），而干预后IS的变化（A130／AG30）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。

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 measured. Insulin and glucose of 0, 30, 60 and 120 min 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 After normalization of plasma glucose levels for more than 2 weeks, this medication was withdrawn for 48 hours then OGTT repeated to assess IR and IS.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 （ DM1 ： FBG 〈6. 9 retool/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/m^2. The insulin sensitivity and insulin secretion function were compared between the subgroups. （ 1 ） True insulin level in BMI ≥ 24 （ FBG 〈 6.9 mmol/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-obese groups. （2） Insulin secretion function recovered better in the obese group when ameliorating glucose toxicity.