Relationship between modified homeostasis model assessment/correlative serum factors and diabetic retinopathy among type 2 diabetics with insulin therapy in Guangzhou, China

AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function and the development of DR.Beta-cell function was assessed by a modified homeostasis model assessment(modified HOMA)which was gained by using C-peptide to replace insulin in the homeostasis model assessment(HOMA)of beta-cell function.We also studied the relationships between modified HOMA index and serum C-peptide response to 100 g tasteless steamed bread to determine the accuracy of modified HOMA.RESULTS:Our study group consisted of 170 type 2diabetic inpatients with DR(age:58.35±13.87y,mean±SD)and 205 type 2 diabetic inpatients with no DR(NDR)(age:65.52±11.59y).DR patients had higher age,longer diabetic duration,higher hypertension grade,higher postprandial plasma glucose,higher fluctuation level of plasma glucose,lower body mass index(BMI),lower postprandial serum insulin and C-peptide,lower fluctuation level of serum insulin and C-peptide(P【0.05).In our logistic regression model,duration of diabetes,hypertension grade,fasting plasma insulin and glycosylated hemoglobin(HbA1C)were significantly associated with the presence of DR after adjustment for confounding factors(P【0.05).CONCLUSION:Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman’s rank-correlationanalysis,logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors(such as age,sex,duration of diabetes,BMI,hypertension grade,HbA1C,plasma insulin).Duration of diabetes,hypertension grade,fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.

Surrogate markers of insulin resistance:A review

Insulin resistance is a hallmark of obesity,diabetes,and cardiovascular diseases,and leads to many of the abnormalities associated with metabolic syndrome. Our understanding of insulin resistance has improved tremendously over the years,but certain aspects of its estimation still remain elusive to researchers and clinicians.The quantitative assessment of insulin sensitivity is not routinely used during biochemical investigations for diagnostic purposes,but the emerging importance of insulin resistance has led to its wider application research studies.Evaluation of a number of clinical states where insulin sensitivity is compromised calls for assessment of insulin resistance. Insulin resistance is increasingly being assessed in various disease conditions where it aids in examining their pathogenesis,etiology and consequences. The hyperinsulinemic euglycemic glucose clamp is the gold standard method for the determination of insulin sensitivity,but is impractical as it is labor-and time-intensive.A number of surrogate indices have therefore been employed to simplify and improve the determination of insulin resistance.The object of this review is to highlight various aspects and methodologies for current and upcoming measures ofinsulin sensitivity/resistance.In-depth knowledge of these markers will help in better understanding and exploitation of the condition.

Role of visfatin in obesity-induced insulin resistance

The growing worldwide burden of insulin resistance(IR) emphasizes the importance of early identification for improved management.Obesity,particularly visceral obesity,has been a key contributing factor in the development of IR.The obesity-associated chronic inflammatory state contributes to the development of obesity-related comorbidities,including IR.Adipocytokines,which are released by adipose tissue,have been investigated as possible indicators of IR.Visfatin was one of the adipocytokines that attracted attention due to its insulinmimetic activity.It is released from a variety of sources,including visceral fat and macrophages,and it influences glucose metabolism and increases inflammation.The relationship between visfatin and IR in obesity is debatable.As a result,the purpose of this review was to better understand the role of visfatin in glucose homeostasis and to review the literature on the association between visfatin levels and IR,cardiovascular diseases,and renal diseases in obesity.

Association of β-cell function and insulin resistance with pediatric type 2 diabetes among Chinese children

BACKGROUND In addition to insulin resistance,impaired insulin secretion has recently been identified as a crucial factor in the pathogenesis of type 2 diabetes mellitus(T2DM).Scarce clinical data exist for pediatric T2DM.AIM To investigate the association ofβ-cell function and insulin resistance with pediatric T2DM in the first Chinese multicenter study.METHODS This multicenter cross-sectional study included 161 newly diagnosed T2DM children and adolescents between January 2017 and October 2019.Children with normal glycemic levels(n=1935)were included as healthy control subjects.The homeostasis models(HOMAs)were used to assess theβ-cell function(HOMA2-%B)and insulin resistance(HOMA2-IR)levels.The HOMA index was standardized by sex and age.We performed logistic regression analysis to obtain odds ratios(ORs)for T2DM risk using the standardized HOMA index,adjusted for confounding factors including sex,Tanner stage,T2DM family history,body mass index z-score,and lipid profile.RESULTS The male-female ratio of newly diagnosed T2DM patients was 1.37:1(OR=2.20,P=0.011),and the mean ages of onset for boys and girls were 12.5±1.9 years and 12.3±1.7 years,respectively.The prevalence of related comorbidities including obesity,elevated blood pressure,and dyslipidemia was 58.2%,53.2%,and 80.0%,respectively.The T2DM group had lower HOMA2-%B levels(P<0.001)and higher HOMA2-IR levels(P<0.001)than the control group.Both the decrease in HOMA2-%B z-score(OR=8.40,95%CI:6.40-11.02,P<0.001)and the increase in HOMA2-IR z-score(OR=1.79,95%CI:1.60-2.02,P<0.001)were associated with a higher risk of T2DM,and the decrease in HOMA2-%B z-score always had higher ORs than the increase in HOMA2-IR z-score after adjusting for confounding factors.CONCLUSION Besides insulin resistance,β-cell function impairment is also strongly associated with Chinese pediatric T2DM.Gender difference in susceptibility and high comorbidities warrant specific T2DM screening and prevention strategies in Chinese children.

Insulin Sensitivity and Insulin Secretion Estimated by Homeostatic Model Assessment (HOMA) in Gestational Diabetes Mellitus

Background: Progressive insulin resistance (IR) is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). Homeostatic model assessment (HOMA) is commonly used as a parameter of the severity of insulin resistance. Aims: To determine indices of insulin resistance (IR) and β-cell function in gestational diabetes mellitus (GDM). Methods: This cross sectional study was conducted from March 2017 to September 2018 at Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was performed with 41 GDM and equal number of pregnant women with normal glucose tolerance (NGT) diagnosed on basis of WHO criterion-2013 during 24 - 40 weeks of gestation. Serum glucose was measured by glucose oxidase method and fasting serum insulin was measured by chemiluminescent immunoassay. Equations of homeostatic model assessment (HOMA) were used to calculate insulin indices like-insulin resistance (HOMA-IR), β-cell function (HOMA-B) and insulin sensitivity (HOMA-%S). Data were analyzed and compared by statistical tests. Results: A total of eighty-two (82) subjects [41 women with GDM (age: 28.29 ± 3.79 years, BMI: 27.16 ± 4.13 kg/m2) and 41 women with NGT (age: 26.22 ± 5.13 years, BMI: 25.27 ± 3.01 kg/m2)] were included in this study. It was observed that GDM women were significantly older (p = 0.041) and had significantly higher BMI (p = 0.020) than pregnant women with NGT. The GDM group had significantly higher IR as indicated by higher fasting insulin value [GDM vs. NGT;10.19 (7.71 - 13.34) vs. 6.88 (5.88 - 8.47) μIU/ml, median (IQR);p = 0.001] and HOMA-IR [GDM vs. NGT;2.31 (1.73 - 3.15) vs. 1.42 (1.15 - 1.76), median (IQR);p < 0.001], poor β-cell secretory capacity [GDM vs. NGT;HOMA-B: 112.63 (83.52 - 143.93) vs. 128.60 (108.77 - 157.58), median (IQR);p = 0.04] and low insulin sensitivity [GDM vs. NGT;HOMA-%S: 43.29 (31.77 - 57.98) vs. 70.42 (56.86 - 86.59), median (IQR);p < 0.001]. Conclusions: GDM is associated with both insulin resistance and inadequate insulin secretion.

The Association of Visceral Adiposity Index with Insulin Resistance in Adults with Prediabetes

Visceral adiposity mediates insulin resistance, but their association among adults with prediabetes is scarce in the literature. This study is aimed to determine the association of visceral adiposity index (VAI) with insulin resistance in adults with prediabetes. This cross-sectional study was done among 117 adults with newly detected prediabetes [m/f;23/94;mean ± SD: Age 36.30 ± 9.99 years, BMI 28.89 ± 4.35 kg/m2] based on American Diabetes Association 2018 criteria and 141 matched healthy controls [m/f: 28/113;mean ± SD: 35.30 ± 6.88 years, BMI 25.03 ± 4.58]. Waist circumference, body mass index, fasting triglyceride, HDL cholesterol, fasting blood glucose and insulin were measured in each group to calculate VAI and homeostatic model assessment of insulin resistance (HOMA-IR). People with prediabetes had significantly higher median value of VAI {3.08 (2.26) vs. 1.86 (2.31);p < 0.001} with higher frequency of high VAI (>1) (98.3% vs. 85.8%;p < 0.001) than the control population. HOMA-IR level was significantly higher in prediabetes with high VAI (cut-off of 2.64) than control with normal VAI [2.78 (2.22, 4.15) vs. 2.20 (1.53, 3.36);p = 0.002]. VAI was positively correlated with HOMA-IR in females with prediabetes (r = 0.299, p = 0.003). VAI had predictive association with prediabetes [OR (95% CI: 9.504 (2.173, 41.576);p = 0.03] and high insulin resistance (HOMA-IR ≥ 2.6) in females with prediabetes [OR (95% CI) = 3.50 (1.476, 8.297);p = 0.004] only. It could satisfactorily discriminate prediabetes in both sexes (male: AUC = 0.767, p = 0.001;female: AUC = 0.641, p < 0.001) and high insulin resistance in females with prediabetes (AUC = 0.641;p = 0.019) only. So, VAI was associated with prediabetes and insulin resistance only in females with prediabetes.

Immunosuppressive therapy in pancreas and islet transplant: Need for simultaneous assessment of insulin sensitivity and secretion

Diabetes mellitus is a metabolic disease possible to treat via pancreas/islet transplantation but most immunosuppressive drugs are diabetogenic. In this letter, we review current up to date methods to assess insulin action and secretion (using the surrogate indexes) suggesting their use in large studies in populations of pancreas/ islets transplanted patients.

Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome

BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.

Salivary resistin level and its association with insulin resistance in obese individuals

The escalating global burden of type 2 diabetes mellitus necessitates the implementation of strategies that are both more reliable and faster in order to improve the early identification of insulin resistance(IR)in high-risk groups,including overweight and obese individuals.The use of salivary biomarkers offers a promising alternative to serum collection because it is safer,more comfortable,and less painful to obtain saliva samples.As obesity is the foremost contributory factor in IR development,the adipocytokines such as leptin,adiponectin,resistin,and visfatin secreted from the adipose tissue have been studied as potential reliable biomarkers for IR.Measurement of salivary adipokines as predictors for IR has attracted widespread attention because of the strong correlation between their blood and salivary concentrations.One of the adipokines that is closely related to IR is resistin.However,there are conflicting findings on resistin’s potential role as an etiological link between obesity and IR and the reliability of measuring salivary resistin as a biomarker for IR.Hence this study reviewed the available evidence on the potential use of salivary resistin as a biomarker for IR in order to attempt to gain a better understanding of the role of resistin in the development of IR in obese individuals.

Hepatitis C virus induced insulin resistance impairs response to anti viral therapy

Hepatitis C virus (HCV) infection is an important risk factor for insulin resistance (IR). The latter is the pathogenic foundation underlying metabolic syndrome, steatosis and cirrhosis, and possibly hepatocellular carcinoma (HCC). The interplay between genetic and environmental risk factors ultimately leads to the development of IR. Obesity is considered a major risk factor, with dysregulation of levels of secreted adipokines from distended adipose tissue playing a major role in IR. HCV-induced IR may be due to the HCV core protein inducing proteasomal degradation of insulin receptor substrates 1 and 2, blocking intracellular insulin signaling. The latter is mediated by increased levels of both tumour necrosis factor-α (TNF-α) and suppressor of cytokine signaling 3 (SOC-3). IR, through different mechanisms, plays a role in the development of steatosis and its progression to steatohepatitis, cirrhosis and even HCC. In addition, IR has a role in impairing TNF signaling cascade, which in turn blocks STAT-1 translocation and interferon stimulated genes production avoiding the antiviral effect of interferon.

Nonalcoholic steatohepatitis and insulin resistance in children

Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis(NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome.The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease(NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH,a "two-hit" model involving triglyceride accumulation(first hit) and liver damage(second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore,insulin resistance may be important in the first hit.Because there is obvious familial clustering in NASH,genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.

hs-CRP、HOMA-IR、SHBG与多囊卵巢综合征合并不孕症病情和预后的相关性

目的探讨超敏C-反应蛋白(hs-CRP)、稳态模型胰岛素抵抗指数(HOMA-IR)、性激素结合球蛋白(SHBG)与多囊卵巢综合征(PCOS)合并不孕症患者病情和预后的相关性。方法选取2020年1月至2022年2月海安市人民医院收治的158例PCOS患者作为研究对象。根据子宫内膜容受性(ERT)检测结果分为容受性良好组和容受性不良组,根据促排卵治疗1年后是否受孕分为预后良好组和预后不良组。分析影响PCOS合并不孕症的高危因素;比较不同ERT和预后的hs-CRP、HOMA-IR和SHBG水平;分析PCOS合并不孕症hs-CRP、HOMA-IR、SHBG与体重指数(BMI)、甘油三酯葡萄糖指数(TyG)和抗米勒管激素(AMH)的相关性,绘制受试者工作特征(ROC)曲线分析hs-CRP、HOMA-IR和SHBG的评估效能。结果容受性不良组的hs-CRP和HOMA-IR水平显著高于容受性良好组,SHBG水平显著低于容受性良好组(P<0.05);预后不良组的hs-CRP和HOMA-IR水平显著高于预后良好组,SHBG水平显著低于预后良好组(P<0.05)。Pearson分析显示,PCOS合并不孕症的hs-CRP、HOMA-IR与BMI、TyG呈正相关,与AMH呈负相关(P<0.05);SHBG与AMH呈正相关,与BMI、TyG呈负相关(P<0.05)。ROC曲线显示,hs-CRP、HOMA-IR和SHBG联合诊断PCOS合并不孕症的曲线下面积、灵敏度、特异度均高于任一单项效能(P<0.05)。结论hs-CRP、HOMA-IR和SHBG联合检测对PCOS合并不孕症的病情和预后的评估价值较高。

miR-2467、miR-96-5p在妊娠期糖尿病中的临床意义

目的:探讨微小核糖核酸-2467(miR-2467)、miR-96-5p在妊娠期糖尿病(GDM)中的临床意义。方法:纳入108例GDM住院患者作为GDM组,另选取同期产检的糖耐量正常孕妇82例为对照组。比较2组血清miR-2467、miR-96-5p相对表达量以及空腹血糖(FBG)、餐后2 h血糖(2hFBG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR),分析miR-2467、miR-96-5p与上述血糖指标的相关性。采用Logistic多元回归模型分析GDM发生的危险因素,绘制受试者工作特征曲线,分析miR-2467、miR-96-5p评估GDM的曲线下面积(AUC)。结果:GDM组血清miR-2467表达、FBG、2hPG、HbA1c水平及HOMA-IR高于对照组,miR-96-5p表达低于对照组(P均<0.05)。Pearson相关性分析显示血清miR-2467表达与FBG、2hPG、HbA1c、HOMA-IR呈正相关,血清miR-96-5p表达与上述4项指标呈负相关(P均<0.05)。Logistic多元回归分析示孕早期BMI增长≥1.73kg/m^(2)、孕中期BMI增长≥4.88kg/m^(2)、糖尿病家族史、miR-2467≥3.44是GDM发生的危险因素,miR-96-5p≥1.95是GDM发生的保护因素(P<0.05)。血清miR-2467联合miR-96-5p评估GDM的AUC为0.865,敏感度、特异度分别为91.50%、81.50%。结论:miR-2467、miR-96-5p与GDM患者血糖指标及HOMA-IR存在相关性,对评估GDM具有一定意义。

CTRP6与妊娠期糖尿病患者糖脂代谢功能的相关性

目的分析C1q/肿瘤坏死因子相关蛋白6(CTRP6)与妊娠期糖尿病(GDM)患者糖脂代谢功能的相关性。方法选取50例GDM患者列为病例组,另选择同期孕检的66例正常产妇列为对照组,比较两组的一般资料(年龄、孕周、体质量指数、产次),临床资料(血糖指标、血脂指标、胰岛素功能、CTRP6表达),采用单因素分析、Logistic多因素回归分析归纳可导致GDM发病的危险因素,经Spearman相关性系数验证CTRP6表达与GDM患者糖脂代谢指标及胰岛素功能的相关性。结果Logistic多因素回归分析结果显示,空腹血糖(FBG)≥10.0 mmol/L、糖化血红蛋白(HbA1c)≥10%、甘油三酯(TG)≥2.5 mmol/L、低密度脂蛋白胆固醇(LDL-C)≥2.0 mmol/L、载脂蛋白A5(ApoA5)≤100μg/L、CTRP6≥600μg/L、空腹胰岛素(FINS)≥10 mU/L、胰岛β细胞功能(HOMA-β)≤50、胰岛素抵抗(HOMA-IR)≥2.25为发生GMD的危险因素。经Spearman相关性系数检验,CTRP6表达水平与FBG、HbA1c、TG、LDL-C、FINS、HOMA-IR正相关,与ApoA5、HOMA-β负相关。结论CTRP6表达水平随FBG、HbA1c、TG、LDL-C、FINS、HOMA-IR升高,随ApoA5、HOMA-β降低而不断上升。

Effects of intermittent fasting on health markers in those with type 2 diabetes:A pilot study

AIMTo determine the short-term biochemical effects and clinical tolerability of intermittent fasting (IF) in adults with type 2 diabetes mellitus (T2DM).METHODSWe describe a three-phase observational study (baseline 2 wk, intervention 2 wk, follow-up 2 wk) designed to determine the clinical, biochemical, and tolerability of IF in community-dwelling volunteer adults with T2DM. Biochemical, anthropometric, and physical activity measurements (using the Yale Physical Activity Survey) were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose (SMBG) and fasting duration on a daily basis throughout all study stages, in addition to completing a remote food photography diary three times within each study phase. Fasting blood samples were collected on the final days of each study phase.RESULTSAt baseline, the ten participants had a confirmed diagnosis of T2DM and were all taking metformin, and on average were obese [mean body mass index (BMI) 36.90 kg/m2]. We report here that a short-term period of IF in a small group of individuals with T2DM led to significant group decreases in weight (-1.395 kg, P = 0.009), BMI (-0.517, P = 0.013), and at-target morning glucose (SMBG). Although not a study requirement, all participants preferentially chose eating hours starting in the midafternoon. There was a significant increase (P < 0.001) in daily hours fasted in the IF phase (+5.22 h), although few attained the 18-20 h fasting goal (mean 16.82 ± 1.18). The increased fasting duration improved at-goal (< 7.0 mmol/L) morning SMBG to 34.1%, from a baseline of 13.8%. Ordinal Logistic Regression models revealed a positive relationship between the increase in hours fasted and fasting glucose reaching target values (χ2 likelihood ratio = 8.36, P = 0.004) but not for afternoon or evening SMBG (all P > 0.1). Postprandial SMBGs were also improved during the IF phase, with 60.5% readings below 9.05 mmol/L, compared to 52.6% at baseline, and with less glucose variation. Neither insulin resistance (HOMA-IR), nor inflammatory markers (C-reactive protein) normalized during the IF phase. IF led to an overall spontaneous decrease in caloric intake as measured by food photography (Remote Food Photography Method). The data demonstrated discernable trends during IF for lower energy, carbohydrate, and fat intake when compared to baseline. Physical activity, collected by a standardized measurement tool (Yale Physical Activity Survey), increased during the intervention phase and subsequently decreased in the follow-up phase. IF was well tolerated in the majority of individuals with 6/10 participants stating they would continue with the IF regimen after the completion of the study, in a full or modified capacity (i.e., every other day or reduced fasting hours).CONCLUSIONThe results from this pilot study indicate that short-term daily IF may be a safe, tolerable, dietary intervention in T2DM patients that may improve key outcomes including body weight, fasting glucose and postprandial variability. These findings should be viewed as exploratory, and a larger, longer study is necessary to corroborate these findings.

A nutraceutical combination improves insulin sensitivity in patients with metabolic syndrome

AIM:To test the efficacy of a proprietary nutraceutical combination in reducing insulin resistance associated with the metabolic syndrome(MetS).METHODS:Sixty-four patients with MetS followed at a tertiary outpatient clinic were randomly assigned to receive either placebo or a proprietary nutraceutical combination(AP)consisting of berberine,policosanol and red yeast rice,in a prospective,double-blind,placebo-controlled study.Evaluations were performed at baseline and after 18 wk of treatment.The homeostasis model assessment of insulin resistance(HOMAIR)index was the primary outcome measure.Secondary endpoints included lipid panel,blood glucose and insulin fasting,after a standard mixed meal and after an oral glucose tolerance test(OGTT),ow-mediated dilation(FMD),and waist circumference.RESULTS:Fifty nine patients completed the study,2 withdrew because of adverse effects.After 18 wk there was a signif icant reduction in the HOMA-IR index in the AP group compared with placebo(ΔHOMA respectively-0.6 ± 1.2 vs 0.4 ± 1.9;P < 0.05).Total and low density lipoprotein cholesterol also significantly decreased in the treatment arm compared with placebo(Δlow density lipoprotein cholesterol-0.82 ± 0.68 vs-0.13 ± 0.55 mmol/L;P < 0.001),while triglycerides,high density lipoprotein cholesterol,and the OGTT were not affected.In addition,there were significant reductions in blood glucose and insulin after the standard mixed meal,as well as an increase in FMD(ΔFMD 1.9 ± 4.2 vs 0 ± 1.9 %;P < 0.05)and a significant reduction in arterial systolic blood pressure in the AP arm.CONCLUSION:This short-term study shows that AP has relevant beneficial effects on insulin resistance and many other components of MetS.

糖尿病前期患者CTRPs、HOMA-IR及HOMA-β水平与2型糖尿病发生的相关性及其预测价值

目的糖尿病前期患者补体C1q/肿瘤坏死因子相关蛋白(CTRP)、稳态模型评估胰岛素抵抗指数(HOMA-IR)及稳态模型评估胰岛β细胞功能指数(HOMA-β)与2型糖尿病发生的相关性及其预测价值。方法选择2020年1月—2022年12月于新疆维吾尔自治区人民医院内分泌科收治首次诊断2型糖尿病患者60例作为观察组,首次诊断糖尿病前期患者60例作为对照组。检测并比较2组患者补体C1q/肿瘤坏死因子相关蛋白1(CTRP1)、CTRP3、CTRP9及CTRP12,空腹胰岛素(FINS)、空腹血糖(FPG)、HOMA-IR及HOMA-β。采用相关性分析、回归分析筛选2型糖尿病发生的独立危险因素,应用受试者工作特征曲线(ROC)评价各独立危险因素对2型糖尿病的预测价值。结果观察组患者血清CTRP1水平低于对照组,血清CTRP9、FINS、FPG水平及HOMA-IR及HOMA-β均高于对照组患者(t/P=5.365/0.001、4.626/0.001、1.979/0.050、2.330/0.021、8.988/0.001、5.632/0.001);血清CTRP1与FPG、HOMA-IR及HOMA-β呈负相关(r/P=-0.260/0.004、-0.189/0.039、-0.262/0.004),CTRP9与HOMA-IR及HOMA-β呈正相关(r/P=0.282/0.002、0.262/0.004);血清CTRP9水平、HOMA-IR及HOMA-β升高均是2型糖尿病发生的独立危险因素[OR(95%CI)=5.995(1.514~23.747)、151.722(15.385~1496.220)、1.127(1.005~1.265)],而血清CTRP1水平升高是2型糖尿病发生的独立保护因素[OR(95%CI)=0.907(0.846~0.972)];HOMA-IR对2型糖尿病发生的预测价值最高(AUC=0.884,P<0.001)。结论血清升高是独立保护因素,CTRP9水平、HOMA-IR及HOMA-β均是糖尿病前期患者发生2型糖尿病的独立危险因素,其中HOMA-IR独立预测疾病发生的效能最高,对于临床具有重要指导意义。

肝硬化患者胰岛素抵抗的临床分析

目的·探讨肝硬化患者的胰岛素抵抗情况。方法·收集2013年1月—2017年12月于上海交通大学医学院附属新华医院住院的肝硬化患者的临床资料。回顾性分析肝硬化患者糖代谢指标,包括空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)、空腹胰岛素、胰岛素抵抗指数(homeostasis model assessment-insulin resistance,HOMA-IR);记录肝硬化患者主要并发症,包括食管胃底静脉曲张破裂出血(esophagogastric varices bleeding,EVB)、腹水和肝性脑病(hepatic encephalopathy,HE)。根据肝硬化患者的HOMA-IR,将肝硬化患者分无胰岛素抵抗组(IR≤1.64)和胰岛素抵抗组(IR>1.64),进行各项指标的组间比较。结果·研究共纳入376例肝硬化患者,其中Child-Pugh A级患者162例(43.09%)、B级148例(39.36%)、C级66例(17.55%)。肝硬化主要病因是乙型病毒性肝炎,占43.35%(163例)。376例肝硬化患者中,208例进行了空腹胰岛素水平检测;其中,无胰岛素抵抗组117例(56.25%),胰岛素抵抗组91例(43.75%)。胰岛素抵抗组肝硬化患者体质量指数(body mass index,BMI)显著高于无胰岛素抵抗组(P=0.000);胰岛素抵抗组中2型糖尿病患者的比例亦高于无胰岛素抵抗组(P=0.001)。胰岛素抵抗组肝硬化患者的Child-Pugh分数(6.93±1.99)低于无胰岛素抵抗组(7.63±2.20),差异具有统计学意义(P=0.020)。胰岛素抵抗组中Child-Pugh C级的肝硬化患者所占比例显著低于无胰岛素抵抗组(P=0.028)。在肝硬化并发症方面,胰岛素抵抗组肝硬化患者并发腹水的比例(36.26%)显著低于无胰岛素抵抗组(66.67%),差异有统计学意义(P=0.000)。2组患者并发EVB和HE的比例比较,差异无统计学意义(P>0.05)。结论·肝硬化患者中近半数存在胰岛素抵抗;有胰岛素抵抗的肝硬化患者BMI偏高,Child C级患者比例较低,较少并发腹水。

血尿酸水平和稳态模型胰岛素抵抗指数对代谢综合征患者新发心房颤动的影响及预测价值

目的探讨血尿酸水平和稳态模型胰岛素抵抗指数(HOMA-IR)对代谢综合征(MS)患者新发心房颤动的影响及预测价值。方法本研究采用巢式病例对照研究设计,基于回顾性MS队列。收集2015年1月至2016年12月于黑龙江中医药大学附属第一医院就诊的MS患者,筛选基线调查起5年内新发心房颤动的病例285例为心房颤动组;匹配未发生心房颤动的病例570例为对照组。收集2组患者基线资料,分析基线资料的组间差异;通过构建Logistic回归模型并校正混杂因素,分析血尿酸水平和HOMA-IR与MS患者新发心房颤动的关系;通过受试者工作特征(ROC)曲线进行预测价值分析。结果心房颤动组的血尿酸水平和HOMA-IR均高于对照组,差异均有统计学意义(均P<0.05);血尿酸和HOMA-IR为MS患者新发心房颤动的独立影响因子(均P<0.05)。将血尿酸和HOMA-IR分别按照四分位数(Q1、Q2、Q3、Q4)分层,构建Logistic回归模型。校正全部混杂因素后,血尿酸Q2、Q3、Q4分层新发心房颤动的风险分别为Q1分层的1.752、3.040、4.281倍,HOMA-IR Q3、Q4分层新发心房颤动的风险分别为Q1分层的1.922、2.403倍。血尿酸、HOMA-IR及二者联合预测MS患者新发心房颤动的ROC曲线下面积(AUC)分别为0.757、0.714、0.828;二者联合预测新发心房颤动的AUC高于单一指标(均P<0.05)。结论在MS人群中,血尿酸水平和HOMA-IR是新发心房颤动的独立影响因子,且新发心房颤动的风险与血尿酸水平和HOMA-IR呈正相关;血尿酸水平和HOMA-IR对新发心房颤动均有良好的预测价值,且二者联合对新发心房颤动的预测价值更高。

胰岛素抵抗代谢评分在中老年人群非酒精性脂肪性肝病筛查中的价值研究

目的:探讨胰岛素抵抗代谢评分(METS-IR)在中老年人群非酒精性脂肪性肝病(NAFLD)筛查中的价值。方法:收集40岁及以上人群1281例为研究对象,根据是否患有NAFLD分为非NAFLD组(946例)和NAFLD组(335例)。采集受试者的既往病史,进行体格检查、实验室检查及腹部超声检查。采用Logistic回归模型评价METS-IR与中老年人群NAFLD患病风险的相关性。采用受试者工作特征(ROC)曲线分析METS-IR对中老年人群NAFLD的筛查价值。结果:NAFLD组收缩压、舒张压、腰围、转氨酶、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、体重指数(BMI)、METS-IR、稳态模型评估的胰岛素抵抗指数(HOMA-IR)高于非NAFLD组,高密度脂蛋白胆固醇(HDL-C)低于非NAFLD组(均P<0.05)。单因素Logistic回归分析结果发现,随着BMI、腰围、血压、转氨酶、TG、TC、LDL-C、HbA1c、FBG、FINS、HOMA-IR、METS-IR水平的升高,NAFLD患病风险增加;HDL-C越高,年龄越大,NAFLD患病风险越小(均P<0.05)。根据METS-IR四分位数将中老年人群分位四组,进行多因素Logistic回归分析,结果显示在校正了混杂因素后,以Q1组作为参照,Q2、Q3和Q4组NAFLD患病风险增加(均P<0.05)。ROC曲线分析显示,METS-IR对NAFLD的筛查价值高于HOMA-IR (P<0.05)。结论:在中老年人群中,METS-IR升高与NAFLD患病风险增加独立相关。METS-IR对NAFLD的筛查优于HOMA-IR,比HOMA-IR更有助于中老年人群NAFLD的早期筛查。