不同体质指数与2型糖尿病关系的队列分析

Association between body mass index and the incidence of type 2 diabetes mellitus

目的：拟基于体质指数（body mass index,BMI）,研究胰岛素抵抗（insulin resistance,IR）及胰岛素分泌受损（impaired insulin secretion,IIS）和2型糖尿病（type 2 diabetes mellitus,T2DM）发病率的关系。方法：为期5年的队列研究共纳入未患T2DM的参与者2 857名,并根据BMI对其进行分组（BMI〈23.0,23.0～24.9和≥25.0）。然后,基于胰岛素生成指数和稳态模型中IR值将每组BMI参与者进一步细分为：正常、只有IIS（isolated IIS,i-IIS）、只有IR（isolated IR,i-IR）和同时有IIS和IR（IIS plus IR,IIS＋IR）人群。结果：BMI〈23.0组中,i-IIS和IIS＋IR人群患T2DM的风险明显高于正常人,其风险比（hazard ratios,HRs）及95%置信区间（confidence interval,CI）分别为6.21（3.44,9.75）和8.01（2.85,25.34）;BMI（23.0～24.9）组中,i-IIS[HRs=8.50（3.91,19.67）]、i-IR[HRs=3.16（1.13,8.43）]和IIS＋IR[HRs=20.31（8.74,53.28）]人群患T2DM的风险明显高于正常人;BMI≥25.0组中,i-IIS[HRs=15.58（5.44,44.73）]、i-IR[HRs=7.78（2.56,22.41）]和IIS＋IR[HRs=23.25（8.47,74.68）]人群患T2DM的风险明显高于正常人。BMI与IIS（相关系数r=-0.45,P=0.032）和IR（r=0.61,P=0.010）的发生率分别呈负相关及正相关。结论：BMI〈23.0的人群更可能因IIS患T2DM,而BMI≥23.0的人群则更可能因IR患T2DM。

Objectives：To study the effects of impaired insulin secretion（IIS）and insulin resistance（IR）on the incidence of type 2diabetes mellitus（T2DM）in Chinese people with different body mass indexes（BMI）. Methods：This five-year cohort study recruited2 857 participants without diabetes at baseline. Participants were stratified according to BMI（23.0,23.0-24.9,and≥25）,and then participants in each BMI group were divided into four classes：normal;isolated IIS（i-IIS）;isolated IR（i-IR）;and IIS plus IR based on insulinogenic index and homeostasis model of IR values. Results：The risk of developing T2 DM was higher in i-IIS（HRs=6.21,95%CI=3.44 to 9.75）and IIS plus IR（HRs=8.01,95%CI=2.85 to 25.34）groups than in patients with BMI23.0in normal group. The risk was higher in i-IIS（HRs=8.50,95%CI=3.91 to 19.67;HRs=15.58,95%CI=5.44 to 44.73）,IR（HRs=3.16,95%CI=1.13 to 8.43;HRs=7.78,95%CI=2.56 to 22.41）and IIS plus IR（HRs=20.31,95%CI=8.74 to 53.28;HRs=23.25,95%CI=8.47 to 74.68）groups than in pa tients with BMI 23.0-24.9 and BMI≥25.0 in normal group. The correlation between BMI and the incidence of IIS was negative,and that with IR was positive. Conclusion：Individuals with normal BMI may develop T2 DM mainly through IIS, whereas individuals with high BMI may develop T2 DM primarily through IR.