正常血糖-高胰岛素血症人群的临床特点和向糖尿病转变的趋向

The clinical characteristics and trend of conversion to type 2 diabetes mellitus of individuals with normal glucose tolerance-hyperinsulinemia

目的 探讨正常血糖-高胰岛素血症（NGT-HINS）人群向糖尿病的转归及影响因素.方法 分别于2006年5月和2008年5月对北京市某单位整体人群进行年度体检并行糖尿病筛查.由专门人员对调查人群进行体检和病史问询,除确诊糖尿病者外统一行口葡萄糖耐量试验（OGTF）,检测空腹和2 h血糖（FPG、2hPG）、胰岛素,以评价糖代谢水平.高胰岛素血症（HINS）以空腹胰岛素≥15 mIU/L和（或）服糖后2 h胰岛素≥80 mIU/L判定.结果 2006年和2008年该单位NGT-HINS检出率分别为5.28%和8.76%（P〈0.01）;2006年糖尿病（DM）、糖调节受损（IGR）的检出率分别为3.52%、6.56%,2008年分别为4.42%、6.47%.2008年在652例复检人群中NGT-HINS转为IGR和DM的分别为18.6%和2.3%,高于正常血糖-正常胰岛素（NGT-NINS）人群的5.4%（P〈0.01）和0.7%;但NGT-HINS人群转为DM的百分率仍低于IGR人群转为DM者（26.3%,P〈0.01）.2006年NGT-HINS人群的腰围、BMI、FPG、2hPG、TG高于NGT-NINS人群（P〈0.01）,HDL-C低于NGT-NINS人群（P〈0.01）;校正胰岛素抵抗后的胰岛细胞功能（HBCI/IR）低于NGT-NINS人群（P〈0.01）,但高于IGR人群（P〈0.01）.logistic回归分析显示,年龄、TG、HBCI/IR是影响NGT人群转归的危险因素.结论 NGT-HINS人群转为糖代谢异常的百分率明显高于NGT-NINS人群,与其合并代谢危险因素增加、胰岛β细胞功能下降有关.糖尿病早期防治应关注NGT-HINS人群.

Objective To study the outcomes and influencing factors of the conversion from normal glucose tolerance -hyperinsulinemia （NCT-HINS） to diabetes in the population of a community in Beijing.Methods All the subjects investigated received 75 g oral glucose tolerance test （OGTT） for diabetes screening carried out in May, 2006 and May, 2008. Data were calculated to analyze the outcomes and influencing factors of the conversion. HINS was diagnosed if fasting serum insulin ＆ 15 mIU/L and/or 2-hour serum insulin after glucose loading ≥ 80 mIU/L Results The prevalence of NGT-HINS in the community in 2006 and 2008 was 5.28% and 8.67% （P〈0.01） respectively and that of diabetes mellitus （DM） and impaired glucose regulation （IGR） was 3.52% , 6.56% in 2006 and 4.42% ,6.47% in 2008.The probability of the conversion from NGT-HINS to IGR and DM was 18.6% and 2.3% , being much higher than that from normal glucose tolerance- normoinsulinemia （NGT-NINS） （5.4% and 0.7% , P 〈0.01）. However, the probability of the conversion from NGT-HINS to DM was 2.3% , which was much lower than that from IGR （26.3% , P 〈0.01）. The reason might be that individuals with NGT-HINS had a higher waist circumference, BMI, fasting plasma glucose, 2 h plasma glucose and TG but a lower HDL-C than individuals with NGT-NINS in 2006. The HOMA β-cell function index/HOMA insulin resistance index （HBCI/IR） of individuals with NGT-HINS was much lower than that of individuals with NGT-NINS, but much higher than that of individuals with IGR. Logistic regression analysis showed that age, TG and HBCI/IR were the major influencing factors of the conversion from NGT to glucose metabolic disorders.Conclusions The probability of conversion from NGT to DM was increased remarkably when HINS was diagnosed. The reason might be that individuals with NGT-HINS suffered more metabolic risk factors and had a decreased β-cell function. Therefore, individuals with NGT-HINS should be paid attention to in diabetes prevention study.