社区老年正常糖耐量人群胰岛素抵抗和胰岛β细胞功能研究

Insulin resistance and β-celi function in old subjects with normal glucose tolerance in a community

入选老年正常糖耐量（NGT）者2929名、糖耐量受损（IGT）者448例和2型糖尿病（T2DM）患者1143例。NGT者根据空腹血糖（FBG）四分位数和十分位数分别分为4个亚组和10个亚组。结果显示，中国老年NGT人群随着血糖升高，空腹胰岛素和稳态模型评估的胰岛素抵抗指数（HOMA—IR）逐渐升高。以HOMA—IR的75％位点2．15为切割点，≥2．15者在4个NGT亚组、IGT组、T2DM组中的比例逐渐升高；超重或肥胖、高血压和高甘油三酯组HOMA—IR≥2．15比例明显升高；相反，中国老年NGT人群中随着血糖升高，稳态模型评估的胰岛p细胞功能指数（HOMA—β）逐渐下降，以HOMA—β25％位点41．79为切割点．〈41．79者在4个NGT亚组、IGT组、T2DM组中的比例逐渐升高；非肥胖、正常血压和正常甘油三酯血症患者HOMA-β〈41．79的比例明显升高。logistic同归分析显示年龄和处置指数是影响老年2型糖尿病独立的危险因素。

A total of 2 929 subjects with normal glucose tolerance（ NGT）, 448 impaired glucose tolerance （IGT）, and 1 143 patients with type 2 diabetes mellitus （T2DM） in a community were enrolled in this study. Homeostasis model assessment （ HOMA ） was applied to evaluate the status of insulin resistance and β-cell function. Furthermore, insulin sensitive check index （QUICK） and deposition index （D1） were caculated. The subjects with NGT were assigned into 4 subgroups and 10 subgroups according to quartiles and deciles of fasting blood glucose （FBG）. The results showed that the levels of fasting insulin and homeostasis model assessment for insulin resistant index（HOMA-IR） were elevated while homeostasis model assessment for β-cell function （ HOMA-β） were decreased with the increase of FBG level in NGT group. The ratio of HOMA-IR ≥2.15 was increased step by step in 4 NGT subgroups, IGT group, and T2DM group, being higher in obesity group, hypertension group, and hypertriglyceridemia group compared with normal subjects. On the contrary, the ratio of HOMA-β 〈41. 79 was gradually increased in 4 NGT subgroups, IGT group, and T2DM group, being higher groups with normal body weight, normal blood pressure, and normal triglyceridemia compared with corresponding abnormal groups. Logistic regression analysis showed that deposition index and age were the independent risk factors of type 2 diabetes mellitus in old subjects.