初诊2型糖尿病患者糖负荷后胰岛素峰值的影响因素研究

Influencing Factors of Post-load Peak Insulin Level in Newly Diagnosed Type 2 Diabetic Patients

背景糖负荷后胰岛素最大分泌能力影响初诊2型糖尿病(T2DM)患者的远期预后,研究其影响因素对初诊T2DM的临床诊治具有重要意义。目的探讨初诊T2DM患者糖负荷后胰岛素峰值(Imax)的影响因素。方法选取2015年10月—2019年10月于武汉科技大学附属孝感医院内分泌科住院的初诊T2DM患者411例,根据糖负荷后Imax三分位数将其分为低Imax组(Imax<21.40 mU/L,n=137)、中Imax组(21.40 mU/L≤Imax<48.10 mU/L,n=137)和高Imax组(Imax≥48.10 mU/L,n=137)。收集患者的一般资料等观察指标。行标准口服葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)检测患者0、30、60、120、180 min血糖(G)及胰岛素(I),计算早相胰岛素分泌指数(ΔI30/ΔG30)、胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)。通过多项式曲线拟合获得糖负荷后血糖峰值(Gmax)和Imax。采用多因素Logistic回归分析探究初诊T2DM患者Imax的影响因素。结果BMI、ΔI30/ΔG30、HOMA-β和HOMA-IR随Imax的升高而增高(P<0.05);G0、G30、G60、G120、G180、Gmax和HbA_(1c)随Imax的升高而降低(P<0.05);低Imax组男性占比高于中Imax组和高Imax组,而高血压、非酒精性脂肪肝病患病率低于中Imax组和高Imax组(P<0.05);高Imax组高尿酸血症患病率高于低Imax组和中Imax组(P<0.05);高Imax组红细胞计数、血红蛋白低于低Imax组(P<0.05)。Spearman秩相关分析结果显示,Imax与BMI、ΔI30/ΔG30、HOMA-β、HOMA-IR呈正相关(P<0.05);Imax与G0、G30、G60、G120、G180、Gmax、HbA_(1c)、红细胞计数、血红蛋白呈负相关(P<0.05)。多因素Logistic回归分析显示,性别〔OR=0.392,95%CI(0.192,0.803)〕、高血压〔OR=1.745,95%CI(1.028,2.967)〕、高尿酸血症〔OR=2.801,95%CI(1.408,5.587)〕、G0〔OR=0.679,95%CI(0.504,0.913)〕、G180〔OR=0.875,95%CI(0.778,0.985)〕、HbA_(1c)〔OR=0.802,95%CI(0.688,0.935)〕、ΔI30/ΔG30〔OR=2.394,95%CI(1.725,3.322)〕、HOMA-IR〔OR=1.829,95%CI(1.414,2.367)〕是初诊T2DM患者Imax的影响因素(P<0.05)。结论初诊T2DM患者空腹血糖、HbA_(1c)与Imax呈负相关,性别、高血压、高尿酸血症、G0、G180、HbA_(1c)、ΔI30/ΔG30、HOMA-IR是初诊T2DM患者Imax的影响因素,因此优先控制空腹血糖使HbA_(1c)达标,对于改善初诊T2DM患者糖负荷后胰岛素最大分泌功能具有重要意义。

Background The ability of islets to secrete insulin in response to glucose could affect the long-term prognosis of newly diagnosed type 2 diabetes mellitus(T2DM),so studying the associated factors is of vital significance for clinical diagnosis and treatment of newly diagnosed T2DM.Objective To explore the influencing factors of post-load peak insulin secretion(Imax)in newly diagnosed T2DM.Methods 411 newly diagnosed T2DM inpatients were recruited from Department of Endocrinology,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from October 2015 to October 2019.Data were collected,including demographics and other observation indicators,blood glucose levels measured at 0,30,60,120,180 minutes(G0,G30,G60,G120,G180)during a 3-hour 75 g oral glucose tolerance test(OGTT),and insulin levels measured at 0,30,60,120,180 minutes(I0,I30,I60,I120 and I180)in a 3-hour insulin response test,and calculated first-phase insulin secretion index(ΔI30/ΔG30 ratio),HOMA-β,and HOMA-IR.The postload peak blood glucose(Gmax)and Imax were obtained by polynomial curve fitting.By post-load Imax tertiles,the patients were divided into low Imax group(Imax<21.40 mU/L,n=137),medium Imax group(21.40 mU/L≤Imax<48.10 mU/L,n=137)and high Imax group(Imax≥48.10 mU/L,n=137).The influencing factors of Imax was explored by multivariate Logistic regression.Results BMI,ΔI30/ΔG30,HOMA-βand HOMA-IR increased with the increment of Imax(P<0.05).G0,G30,G60,G120,G180,Gmax and HbA1c decreased with the increment of Imax(P<0.05).Low Imax group had higher proportion of men,and lower prevalence of hypertension and non-alcoholic fatty liver disease than other two groups(P<0.05).The prevalence of uricemia of high Imax group was higher than that of other groups(P<0.05).The red blood cell count and hemoglobin of high Imax group were lower than those of low Imax group(P<0.05).Spearman correlation analysis indicated that Imax was positively correlated with BMI,ΔI30/ΔG30,HOMA-β,and HOMA-IR(P<0.05),while was negatively correlated with G0,G30,G60,G120,G180,Gmax,HbA1c,red blood cell count and hemoglobin(P<0.05).Multivariate logistic regression analysis showed that gender〔OR=0.392,95%CI(0.192,0.803)〕,hypertension〔OR=1.745,95%CI(1.028,2.967)〕,hyperuricemia〔OR=2.801,95%CI(1.408,5.587)〕,G0〔OR=0.679,95%CI(0.504,0.913)〕,G180〔OR=0.875,95%CI(0.778,0.985)〕,HbA1c〔OR=0.802,95%CI(0.688,0.935)〕,ΔI30/ΔG30〔OR=2.394,95%CI(1.725,3.322)〕and HOMA-IR〔OR=1.829,95%CI(1.414,2.367)〕were the influencing factors of Imax in patients with newly diagnosed T2DM(P<0.05).Conclusion Fasting blood glucose and HbA1c were negatively correlated with Imax for patients with newly diagnosed T2DM.Gender,hypertension,hyperuricemia,G0,G180,HbA1c,ΔI30/ΔG30 and HOMA-IR may be associated with Imax.Therefore,priority should be given to achieving the target level of HbA1c during glycemic control,which is contributive to improving the ability of islets to secrete insulin in response to glucose.