新诊断2型糖尿病患者糖毒条件下胰岛素敏感性与胰岛素分泌功能的观察

Observation on insulin sensitivity and insulin secretion under the condition of glucose toxicity of newly diagnosed T2DM

目的比较不同HbA1c水平的新诊断T2DM患者血糖、IS与胰岛素分泌功能、慢性并发症等情况。方法选取新诊断T2DM患者210例,根据HbA1c水平分为3组,用稳态模型胰岛素抵抗指数(HOMA-IR)、定量胰岛素敏感指数(QUICKI)、OGTT胰岛素敏感指数(OGIS)评估IS,HOMA-β、AUCIns及AUCR评估胰岛素分泌功能。对HbA1c的影响因素进行逐步多元回归分析。经多个独立样本非参数检验比较各组慢性并发症发生率。结果组间比较显示,随着HbA1c的升高,各时点血糖均明显升高,FIns及餐后2hIns水平明显下降。OGIS、HOMA-β、AUCIns及AUCR均显著下降(P<0.01)。HbA1c与2hPG呈显著正相关(r=0.675,P<0.01),与HOMA-β、OGIS呈显著负相关(r=-0.632,-0.578,P<0.01)。各组慢性并发症发生率均较高,但差异无统计学意义(P>0.05)。结论新诊断T2DM患者已处在高HbA1c水平,IS显著下降,胰岛分泌功能已明显受损,慢性并发症发生率高。

Objective To compare the blood glucose, insulin sensitivity, insulin secretion and chronic complications under the condition of glucose toxicity of newly diagnosed T2DM patients. Methods A total of 210 newly diagnosed T2DM patients were divided into three groups according to their HbAlc levels. The insulin sensitivity was assayed by HOMA-IR, QUICKI, and OGIS. The insulin secretion was discussed with HOMA-β, AUC1s, and AUCR, while the influencing factors of HbAlc were analyzed by stepwise multiple regression analysis, and the incidence of the chronic complications was compared through the non-parameter tests of multiple independent samples. Results The between-group comparison showed that along with the HbAlc elevation, the blood glucose of each time point was significantly increased, but the fasting and 2 hlns were decreased significantly, and the OGIS, HOMA-β, AUC, and AUCR were all decreased significantly （P（0. 01）. HbA1 c was significantly positively correlated with 2 hPG （r= 0. 675, P〈0, 01）, and significantly negatively correlated with HOMA-β and OGIS （r= --0. 632, --0. 578, P〈0. 01）. The incidence of chronic complications in each group was high, but without significant difference among groups （P〈 0.05）. Conclusion The newly diagnosed T2DM patients are in the state of high level of HbA1 c already, their insulin sensitivity and insulin secretion are decreased significantly, and the incidence of chronic complications is high.