Changes of ghrelin following oral glucose tolerance test in obese children with insulin resistance

AIM： To characterize changes in ghrelin levels in response to oral glucose tolerance test （OGTT） and to correlate changes in ghrelin levels with changes in insulin and glucose following OGTT in Chinese obese children of Tanner Ⅰ and Ⅱ stage with insulin resistance. METHODS： 22 obese children with insulin resistance state were divided into four groups according to their Tanner stage and gender： boys of Tanner Ⅰ （fir- Ⅰ ）, boys of Tanner Ⅱ（BT-Ⅱ ）, girls of Tanner Ⅰ （GT- Ⅰ ）, girls of Tanner Ⅱ （GT-Ⅱ）. Ghrelin, insulin and glucose were measured at 0, 30, 60 and 120 rain following OGTT. The control children with normal BMI were divided into control boys of Tanner Ⅰ （CBT- Ⅰ, n = 6）, control boys of Tanner Ⅱ （CBT-Ⅱ, n = 5）, control girls of Tanner Ⅰ （CGT- Ⅰ, n = 6）, control girls of Tanner Ⅱ （CGT-Ⅱ, n = 5）. Fasting serum ghrelin levels were analyzed. RESULTS： Ghrelin levels were lower in obese groups. Ghrelin levels of control group decreased in Tanner Ⅱ stage （CGT- Ⅰ vs CGT-Ⅱ t = -4.703, P = 0.001; CBT- Ⅰ vs CBT- Ⅱ t = -4.794, P = 0.001）. Basal ghrelin levels in fir-Ⅱ decreased more significantly than that in BT- Ⅰ group （t = 2.547, P = 0.029）. Ghrelin levels expressed a downward trend after OGTT among obese children. The decrease in ghrelin levels at 60 min with respect to basal values was 56.9% in BT- Ⅰ. Ghrelin concentrations at 0 min correlated directly with glucose level at 0 min in fir- Ⅰ （r = 0.898, P = 0.015）. There wasn＇t a significant correlation of ghrelin changes with glucose changes and insulin changes during OGTT in obese children with insulin resistance. CONCLUSION： In conclusion, in obese children with insulin resistance, ghrelin levels decreased with advancing pubertal stage. Ghrelin secretion suppression following OGTT was influenced by gender and pubertal stage. Baseline ghrelin levels and ghrelin suppression after OGTT did not significantly correlate with the degree of insulin resistance and insulin sensitivity.

Oral glucose tolerance test in diabetes,the old method revisited

The oral glucose tolerance test(OGTT)has been widely used both in clinics and in basic research for a long time.It is applied to diagnose impaired glucose tolerance and/or type 2 diabetes mellitus in individuals.Additionally,it has been employed in research to investigate glucose utilization and insulin sensitivity in animals.The main aim of each was quite different,and the details are also somewhat varied.However,the time or duration of the OGTT was the same,using the 2-h post-glucose load glycemia in both,following the suggestions of the American Diabetes Association.Recently,the use of 30-min or 1-h post-glucose load glycemia in clinical practice has been recommended by several studies.In this review article,we describe this new view and suggest perspectives for the OGTT.Additionally,quantification of the glucose curve in basic research is also discussed.Unlike in clinical practice,the incremental area under the curve is not suitable for use in the studies involving animals receiving repeated treatments or chronic treatment.We discuss the potential mechanisms in detail.Moreover,variations between bench and bedside in the application of the OGTT are introduced.Finally,the newly identified method for the OGTT must achieve a recommendation from the American Diabetes Association or another official unit soon.In conclusion,we summarize the recent reports regarding the OGTT and add some of our own perspectives,including machine learning and others.

Utility of oral glucose tolerance test in predicting type 2 diabetes following gestational diabetes:Towards personalized care

BACKGROUND Women with gestational diabetes mellitus(GDM)are at a seven-fold higher risk of developing type 2 diabetes(T2D)within 7-10 years after childbirth,compared with those with normoglycemic pregnancy.Although raised fasting blood glucose(FBG)levels has been said to be the main significant predictor of postpartum progression to T2D,it is difficult to predict who among the women with GDM would develop T2D.Therefore,we conducted a cross-sectional retrospective study to examine the glycemic indices that can predict postnatal T2D in Emirati Arab women with a history of GDM.AIM To assess how oral glucose tolerance test(OGTT)can identify the distinct GDM pathophysiology and predict possible distinct postnatal T2D subtypes.METHODS The glycemic status of a cohort of 4603 pregnant Emirati Arab women,who delivered in 2007 at both Latifa Women and Children Hospital and at Dubai Hospital,United Arab Emirates,was assessed retrospectively,using the International Association of Diabetes and Pregnancy Study Groups(IADPSG)criteria.Of the total,1231 women were followed up and assessed in 2016.The FBG and/or the 2-h blood glucose(2hrBG)levels after a 75-g glucose load were measured to assess the prevalence of GDM and T2D,according to the IADPSG and American Diabetes Association(ADA)criteria,respectively.The receiver operating characteristic curve for the OGTT was plotted and sensitivity,specificity,and predictive values of FBG and 2hrBG for T2D were determined.RESULTS Considering both FBG and 2hrBG levels,according to the IADPSG criteria,the prevalence of GDM in pregnant Emirati women in 2007 was 1057/4603(23%),while the prevalence of pre-pregnancy T2D among them,based on ADA criteria,was 230/4603(5%).In the subset of women(n=1231)followed up in 2016,the prevalence of GDM in 2007 was 362/1231(29.6%),while the prevalence of prepregnancy T2D was 36/1231(2.9%).Of the 362 pregnant women with GDM in 2007,96/362(26.5%)developed T2D;142/362(39.2%)developed impaired fasting glucose;29/362(8.0%)developed impaired glucose tolerance,and the remaining 95/362(26.2%)had normal glycemia in 2016.The prevalence of T2D,based on ADA criteria,stemmed from the prevalence of 36/1231(2.9%)in 2007 to 141/1231(11.5%),in 2016.The positive predictive value(PPV)for FBG suggests that if a woman tested positive for GDM in 2007,the probability of developing T2D in 2016 was approximately 24%.The opposite was observed when 2hrBG was used for diagnosis.The PPV value for 2hrBG suggests that if a woman was positive for GDM in 2007 then the probability of developing T2D in 2016 was only 3%.CONCLUSION FBG and 2hrBG could predict postpartum T2D,following antenatal GDM.However,each test reflects different pathophysiology and possible T2D subtype and could be matched with a relevant T2D prevention program.

Repetitiveness of the oral glucose tolerance test in children and adolescents

BACKGROUND Data regarding the most suitable diagnostic method for the diagnosis of glucose impairment in asymptomatic children and adolescents are inconclusive.Furthermore,limited data are available on the reproducibility of the oral glucose tolerance test(OGTT)in children and adolescents who are obese(OB).AIM To investigate the usefulness of the OGTT as a screening method for glucose dysregulation in children and adolescents.METHODS Eighty-one children and adolescents,41 females,either overweight(OW),OB or normal weight(NW)but with a strong positive family history of type 2 diabetes mellitus(T2DM),were enrolled in the present observational study from the Outpatient Clinic of Paediatric Endocrinology of the University Hospital of Patras in Greece.One or two 3-h OGTTs were performed and glucose,insulin and Cpeptide concentrations were measured at several time points(t=0 min,t=15 min,t=30 min,t=60 min,t=90 min,t=120 min,t=180 min).RESULTS Good repetitiveness was observed in the OGTT response with regard to T2DM,while low repetitiveness was noted in the OGTT response with regard to impaired glucose tolerance(IGT)and no repetitiveness with regard to impaired fasting glucose(IFG).In addition,no concordance was observed between IFG and IGT.During the 1st and 2nd OGTTs,no significant difference was found in the glucose concentrations between NW,OW and OB patients,whereas insulin and C-peptide concentrations were higher in OW and OB compared to NW patients at several time points during the OGTTs.Also,OW and OB patients showed a worsening insulin and C-peptide response during the 2nd OGTT as compared to the 1st OGTT.CONCLUSION In mild or moderate disorders of glucose metabolism,such as IFG and IGT,a diagnosis may not be reached using only one OGTT,and a second test or additional investigations may be needed.When glucose metabolism is profoundly impaired,as in T2DM,one OGTT is probably more reliable and adequate for establishing the diagnosis.Excessive weight and/or a positive family history of T2DM possibly affect the insulin and C-peptide response in the OGTT from a young age.

Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis

AIM: To determine if subclinical abnormal glucose tolerance (SAGT) has influence on survival of non-diabetic patients with liver cirrhosis.

Responses to oral glucose challenge differ by physical activity volume and intensity: A pilot study

Background:One-hour postprandial hyperglycemia is associated with increased risk of type 2 diabetes and cardiovascular disease.Physical activity(PA)has short-term beneficial effects on post-meal glucose response.This study compared the oral glucose tolerance test results of 3 groups of people with habitually different levels of PA.Methods:Thirty-one adults without diabetes(age 25.9±6.6 years;body mass index 23.8±3.8 kg/m^2;mean±SD)were recruited and divided into 3 groups based on self-reported PA volume and intensity:low activity<30 min/day of moderate-intensity activity(n=11),moderately active≥30 min/day of moderate-intensity PA(n=10),and very active≥60 min/day of PA at high intensity(n=10).Participants completed an oral glucose tolerance test(50 g glucose)with capillary blood samples obtained at baseline,15 min,30 min,45 min,60 min,90 min,and 120 min post-ingestion.Results:There were no significant differences between groups for age or body fat percentage or glycated hemoglobin(p>0.05).The groups were significantly different in terms of baseline glucose level(p=0.003)and,marginally,for gender(p=0.053)and BMI(p=0.050).There was a statistically significant effect of PA on the 1-h postprandial glucose results(p=0.029),with differences between very active and low activity groups(p=0.008)but not between the moderately active and low activity groups(p=0.360),even when baseline glucose level and gender differences were accounted for.For incremental area under the curve there was no significant effect of activity group once gender and body fat percentage had been accounted for(p=0.401).Those in the low activity group took 15 min longer to reach peak glucose level than those in the very active group(p=0.012).Conclusion:The results suggest that high levels of PA have a beneficial effect on postprandial blood glucose profiles when compared to low and moderate levels of activity.

OGTT试验单项血糖升高的妊娠期糖尿病患者母婴结局分析

目的探究口服糖耐量检测(oral glucose tolerance test,OGTT)试验单项血糖升高的妊娠期糖尿病(gestational diabetes mellitus,GDM)患者母婴结局。方法选择2022年1—12月周宁县医院收治的72例OGTT试验单项升高的GDM患者为研究对象,根据OGTT试验结果分为空腹血糖升高组(n=34),餐后1 h血糖升高组(n=15),餐后2 h血糖升高组(n=23)。比较3组患者饮食运动干预血糖控制达标率、胰岛素治疗占比、分娩方式、不良母婴结局发生情况。结果空腹血糖升高组饮食运动干预后血糖控制达标率低于餐后1 h血糖升高组和餐后2 h血糖升高组,使用胰岛素治疗占比高于餐后1 h血糖升高组和餐后2 h血糖升高组,差异有统计学意义(P均<0.05)。空腹血糖升高组、餐后1 h血糖升高组、餐后2 h血糖升高组分娩方式比较,差异无统计学意义(P>0.05)。空腹血糖升高组巨大儿发生率高于餐后1 h血糖升高组和餐后2 h血糖升高组,差异有统计学意义(P<0.05)。结论在OGTT试验单项指标升高的GDM患者中,应重视空腹血糖升高患者,其血糖控制达标率更低,巨大儿发生率更高。

对OGTT60分钟时相高血糖老年男性患者的7年随访与转归

目的了解口服葡萄糖耐量试验（OGTT）检查时仅显示60分钟时高血糖（1hHG）患者的临床特征和转归。方法对连续7年在我院门诊行糖尿病（DM）普查时行OGTT的老年男性人群中空腹和服糖后2h血糖正常、仅服糖后1h血糖≥11．1mmol／L（OGTT-1hHG）的189患者进行随访，记录相关临床资料（包括高血压、冠心病、脑血管病等相关病史、BMI、血脂等检测指标）和每1～2年复查OGTT的情况，对可能的影响因素进行分析。结果随诊中，由OGTT-1hHG转为DM者19例（10．1％），转为糖耐最低减（IGT）者78例（41．3％），转为正常糖耐量（NGT）者2例（1．1％），保持OGTT-1hHG状态者90例（47．6％）。较同期检出IGT转为DM（21．1％）者比率低（x^2=13．05，P〈0．01），转为NGT者（0．4％）比例略高（x^2=2．46，P〉o．05）。OGTT-1hHG组合并高血压、冠心病、脑血管病及高甘油三酯血症的比例均高于NGT组（P〈0．05），与IGT组相似。结论OGTT-1h高血糖作为OGTT异常的一种特殊表现形式，是糖代谢异常的一个组成部分，其中约1／2将转为DM或IGT，也具有较多血管病变的危险因素，是一个应该关注的人群。

1100～1700nm近红外光谱无创血糖测量的OGTT实验研究

在近红外无创血糖测量的研究中 ,保证校正集模型数据的可靠性和所需的数据量具有极其重要的意义。本研究采用蠕动泵取血的 OGTT(口服葡萄糖耐量试验 )实验方法为校正集模型获取足够多的可靠血糖浓度参考值 ,并在 110 0～ 170 0 nm近红外 AOTF(声光可调谐滤波器 )分光系统基础上构建了无创血糖检测系统。利用该系统和实验方法对 3例志愿者进行实验 ,结果表明 ,建立单次实验的 PL S(偏最小二乘 )校正集模型 ,其相关系数分别为 0 .986、0 .971、0 .985 ,完全交互验证下的 RMSEP(预测均方根误差 )分别为 0 .5 5 0、0 .4 5 6、0 .5 2 0 mm ol/ l。此外 ,随着有效数据量增加 ,所建立模型的预测误差减小。

不同孕前BMI孕妇OGTT特点及与GDM检出率的关系

目的探讨不同孕前身体质量指数(BMI)水平孕妇葡萄糖耐量试验(OGTT)血糖值的特点,并分析不同孕前BMI与妊娠期糖尿病(GDM)检出率的相关性。方法回顾性收集2015年1月至2017年12月在海南省海口市妇幼保健院住院分娩并接受75g OGTT的4 898例孕妇作为研究对象,并按照孕前BMI水平分为轻体质量(BMI<18.5kg/m2)、正常体质量(BMI 18.5~23.9kg/m2)、超重(BMI 24.0~27.9kg/m2)和肥胖(BMI≥18.5kg/m2)4组,比较不同孕前BMI水平孕妇75g OGTT血糖值,计算GDM的检出率,分析不同孕前BMI水平与GDM检出率的相关关系。结果 GDM检出率为22.5%(1 102/4 898),轻体质量、正常体质量、超重、肥胖4组GDM检出率分别为:13.3%、20.7%、31.6%、39.2%,随着孕前BMI的上升,GDM的检出率也呈明显上升趋势(χ趋势2=110.175,P<0.001)。轻体质量、正常体质量、超重、肥胖各组孕妇随着孕前BMI的上升,OGTT不同时点(空腹OGTT、OGTT 1h、OGTT 2h)血糖值均呈明显上升趋势(F值分别为92.835、64.455、36.855,均P<0.05);超重组与肥胖组孕妇不同时点(空腹OGTT、OGTT 1h、OGTT 2h)血糖值比较差异均无统计学意义(t值分别为-1.721、-1.316、-0.365,均P>0.05),但这两组孕妇不同时点(空腹OGTT、OGTT 1h、OGTT 2h)血糖值分别与轻体质量组和正常体质量组比较,差异均有统计学意义(超重组与轻体质量组、正常体质量组比较:t值分别为14.075、14.583、9.769、13.650、9.990、6.743,均P<0.05;肥胖组与轻体质量组、正常体质量组比较:t值分别为16.214、15.321、10.187、14.110、10.152、7.589,均P<0.05)。孕前BMI值与血糖异常分组之间存在相关性(r=0.307,P=0.018),孕前BMI值与GDM检出率之间亦存在相关性(r=0.362,P<0.001)。结论随着孕前BMI的增加,孕妇GDM的检出率和OGTT有2项及以上异常者所占比例也相应增加。对于孕前体质量超重或肥胖的孕妇,更应当关注其GDM的发病风险。

OGTT正常、异常及糖尿病患者冠状动脉造影特征比较

目的观察口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)异常对冠心病患者冠脉病变特征的影响。方法对35例糖耐量异常(IGT)及空腹血糖受损(IFG)的冠心病患者的造影结果进行分析,并分析17例OGTT正常的冠心病患者及44例确诊糖尿病患者的冠脉造影结果。结果3组患者的3支病变的构成比有显著差异(P<0.05,P<0.01),远端小血管病变的发生率有显著差异(P<0.05,P<0.01)。结论IGT(或IFG)患者在冠脉病变特征方面与OGTT正常者存在显著差异,而与糖尿病患者存在相似病变特征。

冠心病患者行OGTT试验及糖化血红蛋白检测的必要性研究

目的探讨冠心病患者入院后行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)及检测糖化血红蛋白(HbA1c)的必要性。方法收集10个月因怀疑冠心病而住院的心内科患者116例,住院期间行OGTT试验及冠脉造影并检测HbA1c,比较各组Gensini积分、糖化血红蛋白水平以及二者相关性。结果 OGTT试验发现84例(72.4%)糖代谢异常患者,但空腹血糖检查仅发现10例(9%)。比较三组之间的HbA1c及冠心病病变程度(Gensini积分),冠心病合并糖耐量异常组及冠心病合并糖尿病组分别同单纯冠心病组比较均具差异有统计学意义(P<0.01),冠心病合并糖耐量异常组及冠心病合并糖尿病组比较差异有统计学意义(P<0.05);而三组间的HbA1c与冠心病病变程度相关性良好(R=0.76,P<0.01)。结论对怀疑冠心病住院患者,单纯空腹血糖监测会漏诊大量糖代谢异常患者,冠心病住院患者多合并血糖代谢异常,入院常规的OGTT试验可帮助筛查和明确。HbA1c是冠心病的独立危险因素,入院后常规监测可帮助评估血糖控制情况及预后。

多次OGTT检查对高危孕妇产前诊断及母婴结局的影响

目的 研究行多次OGTT检查对高危孕妇产前诊断妊娠期糖尿病的临床应用价值,并探讨母婴结局。方法 简单随机选择2012年8~11月于湖南省妇幼保健院产科门诊行产前捡查的62例高危孕妇（观察组）,分别于孕24~28周及32~35周进行75 g口服葡萄糖量试验检查。选择同期未按照医嘱及时复查的高危孕妇39例为对照组,观察高危孕妇二次筛查妊娠期糖尿病的检出率及两组孕妇胎盘异常或早产、新生儿Apgar评分和住院时间。结果 高危孕妇二次葡萄糖筛查的检出率为16.13%（10/62）,明显高于首次葡萄糖筛查的检出率4.84%（3/62）,差异有统计学意义（P〈0.05）。观察组新生儿Apgar评分为（8.89±0.06）分,高于对照组的（8.25±0.04）分,差异有统计学意义（P〈0.05）;观察组产妇和婴儿平均住院时间为（6.12±0.08）d,低于对照组的（8.61±0.17）d,差异也有统计学意义（P〈0.05）。结论 对高危孕妇增加二次葡萄糖筛查可以提高妊娠期糖尿病的检出率,为患者的早期诊断和治疗提供更合适的依据,明显改善母婴结局,适合临床推广应用。

循证护理解决OGTT应用静脉留置针采血发生堵管的实践及成效

目的探讨循证护理解决口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)应用静脉留置针法采血发生堵管的实践及成效。方法对2009年1-8月(循证护理实施前)静脉留置针法应用OGTT采血过程中堵管的情况进行原因分析,应用计算机网络检索有关文献,并对证据的真实性、可靠性及临床实用性做出评价,确定结论,制订防范对策,并将对策于2009年9月-2010年6月在静脉留置针法应用OGTT采血过程实施。比较循证护理前后两组患者堵管发生率。结果实施循证护理前后两组患者OGTT应用静脉留置针采血堵管率分别为9.0%和3.8%,两组比较,P﹤0.05,差异具有统计学意义。结论循证护理能解决OGTT应用静脉留置针采血发生堵管问题,提高OGTT采血成功率,而且可丰富护士专业知识,进一步提高护士的专业技能。

肝源性糖尿病患者OGTT和胰岛素释放试验的结果分析

目的探讨口服葡萄糖耐量试验(OGTT)和胰岛素释放试验在肝源性糖尿病中的应用价值。方法应用己糖激酶法和放免法对60例肝源性糖尿病、57例2型糖尿病进行了OGTT、胰岛素释放试验检测。结果肝源性糖尿病患者与2型糖尿病患者在OGTT中120!min、180!min差异有显著性(t!=2.78,P<0.05,t!=3.85,P<0.01),其余各时间段差异均无显著性(P>0.05),胰岛素水平呈高基础值血症型。结论OGTT和胰岛素释放试验在鉴别肝源性糖尿病中有一定的应用价值。

FPG联合选择性OGTT模式在糖尿病筛查中的应用研究

探索空腹血糖(FPG)和选择性口服葡萄糖耐量试验(OGTT)相结合的糖尿病(DM)筛查模式。应用OGTT对无DM史人群行DM筛查,运用ROC曲线评价FPG对DM、IPH的诊断价值。FPG切点为7.0mmol/L时,诊断DM的敏感性为69%,特异性为100%;FPG切点为5.6mmol/L时,诊断IPH的敏感性为100%,特异性为83.3%。对FPG初筛在5.6mmol/L～6.9mmol/L者行OGTT,可在保证筛查准确性的基础上,最大程度节约成本。

空腹血糖及OGTT1h血糖对糖尿病诊断意义的比较

目的:比较空腹血糖(FPG)及口服糖耐量试验(OGTT)1h血糖(PG)诊断糖尿病灵敏度和特异度的差异及其与胰岛B细胞功能及胰岛素抵抗的关系。方法:选取需行OGTT的4 430名受试者。用接受者工作特征(ROC)曲线计算出OGTT1hPG诊断糖尿病的最佳切点,后将其与FPG进行比较分析。结果:以糖尿病为参考标准,ROC曲线得出OGTT1hPG诊断糖尿病的最佳切点为12.94 mmol/L。以OGTT2hPG≥11.1 mmol/L为诊断糖尿病的金标准,FPG≥7.0mmol/L诊断糖尿病的灵敏度为62.91%,特异度为96.46%;OGTT1hPG≥12.94 mmol/L诊断糖尿病的灵敏度为83.62%,特异度为88.42%。FPG和1hPG与胰岛素抵抗指数(HOMA-IR)呈正相关(P<0.01);与HOMA-B呈负相关(P<0.01);与胰岛素生成指数呈负相关(P<0.01)。结论:单纯用FPG诊断糖尿病漏诊率高,1hPG更有诊断价值,且FPG和1hPG可一定程度反映胰岛B细胞功能及胰岛素抵抗情况。

OGTT 0.5h PG、1h PG诊断糖尿病和糖调节受损的切点值估测

目的查找正常人、空腹血糖受损(IFG)和葡萄糖耐量减低(IGT)患者在口服葡萄糖耐量试验(OGTT)时,0.5 h血糖(0.5 h PG)、1 h血糖(1 h PG)95%的参考值范围以及其诊断糖尿病和糖调节受损的血糖值切点。方法分析天津医科大学第二医院近5年来有完整资料的3208例OGTT结果,将其分成正常人组、IFG组、IGT组和糖尿病组,并计算每组各时间点的血糖均值和标准差(x-±s),并用公式(x-+1.64s)计算出除糖尿病组外各组人群各时间点95%的参考值范围。结果正常人、IFG、IGT三组人群0.5 h PG、1 h PG 95%的参考值范围分别是:①正常人应<11.58 mmol/L、<11.69 mmol/L。②IFG患者应<12.93 mmol/L、<14.11 mmol/L。③IGT患者应<12.75 mmol/L、<14.49 mmol/L。结论①因正常人OGTT 0.5 h PG、1 h PG两点的参考范围高限是11.58和11.69 mmol/L,因此,在OGTT结果的判定时,只凭0.5 h PG和1 h PG≥11.1 mmol/L不能诊为糖尿病。②根据计算结果,OGTT 0.5 hPG 12.93 mmol/L,1 h PG 14.49 mmol/L是诊断糖尿病的切点值。③0.5 h PG 11.58 mmol/L,1 h PG11.69 mmol/L是诊断糖调节受损的切点值。

不同糖代谢状态人群OGTT条件下血浆GIP及GC水平变化

目的探讨初诊2型糖尿病(T2DM)、糖调节受损(IGR)及正常糖耐量(NGT)人群OGTT条件下血浆葡萄糖依赖性促胰岛素释放多肽(GIP)及胰高血糖素(GC)水平变化。方法选取16例NGT志愿者,13例IGR及19例初诊T2DM患者,三组均进行口服葡萄糖耐量试验(OGTT),测定0、30、60、90及120 min血浆GIP及GC浓度。结果三组受试者空腹血浆GIP水平[分别为NGT组(20.56±11.49),IGR组(27.04±13.07),T2DM组(20.21±10.44)]无显著差异,其余各时点血浆GIP水平T2DM组[分别为(131.52±43.30)、(153.53±41.53)、(147.72±38.69)、(123.29±36.04)]均较IGR组[分别为(188.26±34.23)、(200.88±18.11)、(190.31±33.32)、(172.91±27.94)]减少,差异有显著性。T2DM组GIP水平在30、90及120 min较NGT组[分别为(184.32±39.65)、(176.20±27.81)、(162.81±30.11)]减少,差异有显著性。T2DM组各时间点GC水平[分别为(102.05±9.10)、(91.37±7.60)、(94.72±8.69)、(82.47±7.15)、(76.21±8.15)]显著高于另外两组[NGT组分别为(63.16±7.89)、(59.15±7.53)、(57.08±7.64)、(55.81±7.60)、(53.11±7.40);IGR组分别为(76.00±3.05)、(71.59±4.45)、(59.16±5.59)、(63.17±5.27)、(58.07±4.73)],差异有显著性。结论初诊T2DM患者糖负荷后血浆GIP水平较NGT及IGR组下降,空腹及糖负荷后胰高血糖素均较NGT及IGR组升高。

OGTT单项升高的妊娠期糖尿病孕妇围产结局分析

目的:分析葡萄糖耐量试验(OGTT)单项升高妊娠期糖尿病(GDM)孕妇的围产结局,为GDM分级管理模式提供临床依据。方法:纳入2015年11月1日至2018年4月30日在浙江大学医学院附属妇产科医院定期产检的OGTT单项升高GDM孕妇2912例,空腹血糖升高者为空腹组,服糖后1h血糖升高者为1h组,服糖后2h血糖升高者为2h组。同期随机纳入1676例正常妊娠孕妇作为正常对照,比较四组间一般资料及围产结局。结果:OGTT单项升高GDM组的年龄及孕前体质量指数(BMI)均显著高于正常妊娠(NGT)组。空腹组初次剖宫产、巨大儿和大于胎龄儿(LGA)的发生率均显著高于NGT组、1h组及2h组。调整孕妇年龄、孕前BMI、孕期增重后logistic回归分析显示,空腹组初次剖宫产、巨大儿和LGA的发生风险分别是正常对照组的1.35倍(95%CI为1.04~1.76)、2.15倍(95%CI为1.49~3.09)及2.37倍(95%CI为1.76~3.18)。结论:OGTT单项升高的GDM孕妇中,应重点关注空腹血糖升高者,以改善GDM围产结局。