中国新诊断2型糖尿病胰岛素分泌和胰岛素抵抗特点调查

目的 研究中国新诊断2型糖尿病患者胰岛素分泌功能(IS)及胰岛素抵抗(IR)状况.方法 对405例新诊断2型糖尿病患者和40名糖耐量正常者(对照组)测量身高、体重;行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验.按空腹血糖(FPG)水平分为4组,与对照组比较.93例FPG≥8.3mmol/L者应用格列齐特(达美康)缓释片进行干预治疗1～3个月,血糖达标后重复OGTT并计算干预后的IR及IS.结果 (1)随着FPG水平的升高,糖尿病各组IR、IS逐级恶化:在FPG≥9.7mmol/L组,胰岛素敏感性为正常组的30%,IS仅为正常组的5%;(2)在FPG<9mmol/L组,IR能解释70%的血糖水平变化,而在FPG高于≥9mmol/L组,IS能解释60%的血糖变化;(3)格列齐特缓释片干预治疗IR及IS有了显著的改善.结论 新诊断2型糖尿病的IR及IS随空腹血糖升高而恶化,但是IS恶化更为严重;这种双重恶化在高血糖状态得到纠正后在相当程度上是可逆的.

Features of insulin secretion and insulin resistance in Chinese newly-diagnosed type 2 diabetes

Objective To investigate the features of insulin secretion(IS)and insulin resistance(IR)in Chinese newly-diagnosed type 2 diabetes. Methods Four hundred and five newly-diagnosed type 2 diabetic patients and forty normal controls were recruited. Their height and weight were measured, and levels of insulin and glucose at 0,30,60 and 120 min during oral glucose tolerance test(OGTT)were examined. The patients were stratified to four groups based on fasting plasma glucose(FPG)level. Their IR and IS were compared to controls. Patients with FPG≥8.3mmol/L were treated with gliclazide(Diamicron)for 1 to 3 months until the normalization of plasma glucose levels for more than 2 weeks. After this medication were discontinued for 48h. OGTT were then repeated to assess changes of IR and IS. Results (1) IR Was increased but IS was decreased along with the increase of FPG levels. Compared with controls, the insulin sensitivity in group with FPG≥9.7mmol/L was 30% of controls, and insulin secretion was only 5%. (2) IR could explain 70% of plasma glucose changes in the group with FPG<9mmol/L, while as in the group with FPG≥9mmol/L, it was the IS rather than IR explained 60% of plasma glucose changes. (3) The glucose levels in 23% of diabetic patients returned to non-diabetic range by the intervention treatment with gliclazide. Their insulin sensitivity and insulin secretion were significantly improved after the normalization of glucose. Conclusion Both IR and IS were worsen with the elevation of FPG in newly-diagnosed type 2 diabetes. however IS was worse than IR. Normalization of hyperglycemia with anti-diabetic agents can improve insulin secretion and ameliorate insulin sensitivity, suggesting that both the deficiencies seem to be reversible.