新诊断T2DM汉、维民族患者HbA1c水平和胰岛细胞功能评价

目的 了解新诊断2型糖尿病（T2DM）汉、维民族间患者不同糖化血红蛋白（HbA1c）水平胰岛α、β细胞功能状况。方法 选取正常体检人群32例、新诊断T2DM患者269例,共分为5组,正常对照组及根据HbA1c水平将新诊断T2DM患者分为A、B、C、D组,进行口服葡萄糖耐量试验（OGTT）、胰岛素释放、胰高血糖素释放试验,比较各组稳态模型评估的胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）、早时相胰岛素分泌指数（△I30/△G30）、第二时相胰岛素分泌指数[胰岛素曲线下面积(AUCIns)]、胰高血糖素、胰高血糖素/胰岛素、胰高血糖素曲线下面积(AUCglu)等指标,评估各组胰岛α及β细胞功能及分析维、汉间是否有差异。结果 新诊断T2DM中,汉、维民族人群BMI、腹围、HOMA-β分别为(25.96±3.26) kg/m²和 (28.10±4.30) kg/m²、（94.24±9.38）cm和（101.56±13.10）cm、3.52±1.01和 3.87±1.32,差异均有统计学意义（P<0.05）,2 h血糖、HOMA-IR、△I30/△G30、AUCIns、AUCglu差异无统计学意义（P>0.05）。与正常体检人群相比,新诊断T2DM患者HOMA-IR明显升高,但在HbA1c≤11.0%的三组未见差异,在HbA1c>11.0%组HOMA-IR反而明显降低（P<0.05）;新诊断T2DM的HOMA-β、△I30/△G30、AUCIns较正常体检人群均明显降低（P<0.05）。 新诊断T2DM各组间空腹及糖负荷后各时相胰高血糖素及AUCglu均无明显改变;空腹及糖负荷后各时相胰高血糖素/胰岛素比值均明显升高（均P<0.05）。结论 新诊断T2DM患者维、汉民族间胰岛β分泌功能有显著差异,两民族间不同HbA1c水平胰岛α、β细胞功能无明显差异,汉族BMI>25 kg/m²者较维族易患T2DM 。

Evaluation of islet α-cell and β-cell functions at different levels of HbA1c in patients with newly diagnosed type 2 diabetes mellitus in Han and Uygur nationalities

Objective To investigate the changes of islet α-cell and β-cell functions at different levels of HbA1c in patients with newly diagnosed type 2 diabetes mellitus (T2DM) in Han and Uygur nationalities. Methods A total of 269 newly diagnosed T2DM patients and 32 normal health examination people were divided into five groups (T2DM Group A, B, C, D according to their HbA1c levels, and a normal control group). The oral glucose tolerance test (OGTT), insulin releasing test, and glucagon releasing were performed. The islet α-cell and β-cell functions assayed by the homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for β-cell function (HOMA-β), early insulin secretion index (△I30/△G30), and second-phase insulin secretion index [using area under curve of insulin (AUCIns)], glucagon, glucagon/insulin and area under curve of glucagon (AUCglu) were compared among all the groups, and the difference between Han and Uygur nationalities was also analyze. Results Among the newly diagnosed T2DM patients, The BMI, abdominal circumference, and HOMA-β in Han and Uygur ethnic groups were (25.96±3.26) kg/m² and (28.10±4.30) kg/m², (94.24±9.38) cm and (101.56±13.10) cm, 3.52±1.01 and 3.87±1.32, respectively, the differences were statistically significant (P<0.05), there was no significant difference in blood glucose, HOMA-IR, △I30/△G30, AUCIns and AUCglu at 2 h (P>0.05). Compared with the normal physical examination population, the HOMA-IR was increased significantly in the patients with newly diagnosed T2DM, but along with the HbA1c elevation, no significant difference was observed among the three groups (Han T2DM group, Uygur T2DM group and normal control group) in HOMA-IR when HbA1c≤11.0%, while HOMA-IR was decreased significantly when HbA1c>11.0%. HOMA-β, △I30/△G30, and AUCIns were all decreased significantly (P<0.05) in the patients with newly diagnosed T2DM compared with those in the normal control group. Glucagon and AUCglu did not significantly change in the patients with newly diagnosed T2DM, but glucagon/insulin increased significantly (P<0.05) with the increase of HbA1c. Conclusion sThe islet beta cell secretion function is significantly different between the Han and Uygur patients with newly diagnosed T2DM, but there is no significant difference between the two ethnic groups in the islet alpha and beta cell functions at the different levels of HbA1c. When BMI>25 kg/cm², the Han population are more susceptible to suffering from T2DM than Uygur people.