新诊断的2型糖尿病患者血糖水平与胰岛素分泌及胰岛素抵抗的关系

Correlation between insulin secretion,insulin resistance and glucose levels in newly diagnosed type 2 diabetic patients

目的:比较不同糖化血红蛋白(HbA1c)水平的新诊断的2型糖尿病(T2DM)患者胰岛素分泌功能和胰岛素抵抗(IR)情况。方法:将235例新诊断为T2DM的患者按HbA1c水平分为3组,即HbA1c组1(HbA1c≤7.5%)、HbA1c组2(7.5%<HbA1c<9.0%)和HbA1c组3(HbA1c≥9.0%)。用稳态模型评估法(HOMA)评价其基础胰岛素分泌功能(HOMA-%β)及胰岛素抵抗指数(HOMA-IR),并用精氨酸刺激试验结果的真胰岛素增值(△TI)、胰岛素原增值(△PI)、血糖校正后的△TI(△TI/PG)及血糖校正后的胰岛素曲线下面积(AUC)评估第一相胰岛素分泌功能。结果:①HbA1c组2、HbA1c组3患者的年龄均显著低于HbA1c组1(P<0.01),HbA1c组3患者的高密度脂蛋白-胆固醇(HDL-C)显著低于HbA1c组1(P<0.05)。②校正年龄、性别、体质指数(BMI)及HOMA-IR后,HOMA-%β在HbA1c组2和HbA1c组3显著低于HbA1c组1(P值均<0.01)。与HbA1c组1及HbA1c组2比较,HbA1c组3的AUC显著降低,而△PI显著升高(P均<0.05)。校正性别、年龄、BMI后,HOMA-IR在在3组间比较,差异无统计学意义。③多元逐步回归分析显示,空腹血糖(FPG)、BMI和HbA1c是HOMA-%β的独立影响因素(P<0.05);BMI、HbA1c和三酰甘油(TG)是△PI的独立影响因素(P均<0.01);腰围(WC)、FPG、BMI是AUC的独立影响因素(P<0.05);BMI、TG是HOMA-IR的独立影响因素。结论:新诊断的T2DM患者存在基础胰岛素分泌及第一相胰岛素分泌的双重缺陷,这种情况在血糖水平较高者中尤为显著,尽管其血糖增高幅度不同,但均存在明显的IR,且这种IR无程度上的差异。

Objective To compare the β cell function and insulin resistance of newly diagnosed type 2 diabetic patients with different HbAlc levels. Methods Two hundred and thirty-five newly diagnosed type 2 diabetes mellitus （T2DM） patients were divided into 3 groups according to HbAlc levels： group 1 with HbAlc≤7.5%, group 2 with 7.5%〈 HbAlc〈9.0% and group 3 with HbAlc≥9.0%. Homeostasis model assessment was used to evaluate basal insulin secretion （HOMA-%β） and insulin resistance （HOMA-IR）. The incremental value of serum tree insulin （ATI）, proinsulin （API） and blood glucose corrected ATI （ATI/PG）, and AUC （area under the curve of TI/PG） after arginine stimulation were used to evaluate first phase insulin secretion. Results ①Age of the patients in group 2 and 3 was significantly lower than that in group 1 （P〈0.01）, and high density lipoprotein cholesterol （HDL-C） level in group 3 was significantly lower than that in group 1 （P〈0.05）. ② After correction for age and gender, body mass index （BMI）, HOMA-IR, HOMA-%β were significant lower in group 2 and group 3 than that in group 1 （all P〈0.01）. Group 3 had a significant lower AUC level and significant higher API than that of group 1 and 2 （all P〈0.05）. There was no significant difference in HOMA-IR between these 3 groups after correction for age, gender and BMI. ③ Multivariate analysis showed that independently influencing factors on HOMA-%β were fasting plasma glucose （FPG）, BMI and HbAlc （all P〈0.01）, on API were BMI, HbAlc and triglycerides （TG） （all P〈0.01）, and on AUC were waist circumference, FPG and BMI （P〈0.05）, respectively. Besides, BMI and TG were the independent variables significantly influencing HOMA-IR （P〈0.05）. Conclusions Newly diagnosed type 2 diabetic patients have dual impairments in both basal and first phase insulin secretion, especially in patients with severe hyperglycemia. Insulin resistance existes at all levels of hyperglycemia and does not show significant differences.