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1.
目的探讨红细胞体积分布宽度(RDW)与2型糖尿病(T2DM)、空腹血糖受损/葡萄糖耐量异常(IFG/IGT)的相互关系。方法对152例在我院定期进行健康体检或治疗的患者,依据血糖情况分为3组,其中T2DM组42例,IFG/IGT组38例,正常对照(NGT)组72例,采取空腹血,采用全自动血液分析仪测定RDW、血红蛋白,多功能血生化自动分析仪测定血总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮和空腹血糖,同时统计高血压、冠心病的发病率并分析其关系。结果RDW在T2DM组、IFG/IGT组和NGT组之间比较具有统计学差异,其中T2DM组和NGT组、IFG/IGT组比较,差异均有统计学意义(P〈0.05或P〈0.01),IFG/IGT组与NGT组比较差异无统计学意义(P〉0.05)。多因素直线回归分析显示空腹血糖(P〈0.01)和高密度脂蛋白胆固醇(P〈0.05)是RDW的独立危险因子。结论T2DM患者RDW升高,RDW的变化与空腹血糖水平相关。  相似文献   

2.
Aims To investigate changes in insulin action and insulin secretion in obese subjects with different categories of impaired glucose regulation (IGR): impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and combined IFG/IGT (CGI). Methods A total of 222 subjects underwent an oral glucose tolerance test and a frequently sampled intravenous glucose tolerance test (FSIGTT); 100 had normal glucose tolerance (subdivided into 32 lean NGT, 68 obese NGT), and 122 were obese with IGR (82 IGT, 14 IFG and 26 CGI). The insulin sensitivity index (SI) was assessed by Bergman's minimal model method with FSIGTT; insulin secretion was determined by acute insulin response to glucose (AIRg). The disposition index (DI), the product of AIRg and SI, was used to determine whether AIRg was adequate to compensate for insulin resistance. Results SI was similar in NGT and IGR obese subgroups. AIRg was significantly increased in obese NGT as compared with lean NGT, significantly reduced in IGT, and further reduced in IFG and CGI subjects as compared with obese NGT subgroups. DI was reduced in NGT obese individuals. Within the obese IGR subgroups, IFG and CGI subjects had even lower DI value than IGT subjects. Conclusions Obese Chinese subjects with IGR have a similar degree of insulin resistance but differ in insulin secretion. Subjects with IFG and CGI have a more prominent deficiency in insulin secretion than subjects with IGT.  相似文献   

3.
糖调节受损个体胰岛β细胞功能和胰岛素抵抗观察   总被引:1,自引:0,他引:1  
评价152例人选者[正常糖耐量、空腹血糖受损和(或)糖耐量受损]胰岛β细胞功能和胰岛素抵抗.结果 显示空腹血糖受损者主要表现胰岛素早期分泌功能缺陷和基础分泌不足,胰岛素抵抗严重;糖耐量受损者则胰岛素早期和晚期分泌功能显著下降伴轻度胰岛素抵抗.  相似文献   

4.
OBJECTIVE: To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS: The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. CONCLUSIONS: In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.  相似文献   

5.
目的研究上海地区肥胖的糖调节受损(IGR)者胰岛素敏感性和胰岛β细胞1相胰岛素分泌功能。方法共有129例受试者[非肥胖正常对照38名,IGR包括单独糖耐量受损(IGT)64例,单独空腹血糖受损(IFG)8例,IFG+IGT 19例]接受了口服75g葡萄糖耐量试验和胰岛素改良的减少样本数(n =12)的Bergman微小模型技术结合频繁采血的静脉葡萄糖耐量试验(FSIGTT)。胰岛素抵抗由FSIGTT中胰岛素敏感性指数(S1)加以评估,而FSIGTT中对葡萄糖急性胰岛素分泌反应(AIRg)则用以评价胰岛β细胞分泌功能。处理指数(DI=AIRg×S1)用于评价AIRg是否代偿机体的胰岛素抵抗。结果(1)与正常对照组相比,3组IGR患者之S1明显降低(均P<0.01),3组差异无统计学意义;(2)AIRg在正常组和IGT组之间差异无统计学意义,但均大于IFG和IFG+IGT组,差异有统计学意义(P<0.05或JP<0.01)。IFG +IGT组的AIRg值显著低于IGT组(P<0.01);(3)与正常组相比,DI指数在3组IGR显著降低(P< 0.01),但在IGR组间差异无统计学意义;(4)S1与空腹胰岛素、体重指数、血清尿酸呈显著负相关(校正r2 =0.568,P<0.01);而AIRg与2h胰岛素显著正相关,与空腹血糖、2h血糖和年龄负相关(校正r2=0.402, P<0.01)。结论上海地区肥胖的初诊IGR患者(包括单独IGT、单独IFG和IFG+IGT患者)存在着程度近似的胰岛素抵抗;急性相胰岛素分泌功能在校正胰岛素抵抗影响因素后IGT患者尚属正常,在IFG和IFG+IGT患者已明显降低,且3组的β细胞代偿功能均为一致性失代偿。  相似文献   

6.
目的评估初发的单纯空腹血糖受损(IFG)和单纯糖耐量受损(IGT)患者的胰岛素分泌以及胰岛素敏感性(IS)特征。方法北京市东城区既往无糖尿病史的2388名受试者行葡萄糖耐量试验,同时行胰岛素释放试验,本文纳入2244例,其中糖耐量正常(NGT)1608例,IFG240例,IGT243例,IFG+IGT 153例。比较各组胰岛素抵抗指数(HOMA-IR)、IS指数(Matsudaindex)、B细胞功能指数(1相Stumvoll index、△I30/△G30)。结果与NGT组比较,其余三组HOMA-IR显著升高,Matsuda指数及B细胞功能指数均显著降低(P均〈0.01);IFG组HOMA-IR及Matsuda指数均高于IGT组;IFG组△I30/△G30高于IGT组,而Stumvoll指数低于IGT组(P〈0.01);与IFG组、IGT组比较,IFG+IGT组HOMA-IR显著升高,Matsuda指数、1相Stumvoll指数显著降低(P均〈0.01)。结论糖尿病前期人群存在不同程度的胰岛素分泌缺陷和IR,IFG组肝IR较重,而IGT组肌肉IR较重。  相似文献   

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8.
Summary Nuclear families of non-insulin-dependent diabetic (NIDDM) patients are uncommon, as usually one or both parents have died. In order to aid identification of complete nuclear families, we have ascertained the disease process at a younger age by studying subjects with previous gestational diabetes. One hundred women who had had gestational diabetes, age (±SD) 38 (6) years, were screened by fasting plasma glucose (fpg). Sixty-one were found to have either fasting hyperglycaemia (5.5fpg<7.8 mmol/l) or diabetes. Of these women 35 had both parents alive and the parents of 14 of these women agreed to the assessment of their metabolism by a continuous infusion of glucose with model assessment (CIGMA). Seven probands had impaired glucose tolerance (IGT) and seven were diabetic. They were age 35 (4) years and had body mass index (BMI) 26 (5) kg/m2. The parents were aged 62 (6) years and had BMI 29 (6) kg/m2 and their affection status was defined as presence of glucose intolerance (fpg or post-infusion achieved plasma glucose level >2 SD of an age and obesity matched population). In the 14 families, five probands (36%) had neither parent affected, six (43%) had one parent affected and three (21%) had both parents affected. Only three probands had a parent with diabetes as defined by World Health Organisation criteria. We concludes that the study of women who have had gestational diabetes allows detection of probands with diabetes or impaired glucose tolerance, who have both parents available for study. A substantial proportion had neither parent affected with impaired glucose tolerance or diabetes, similar to the nuclear families of NIDDM patients. The results are in accord with studies of nuclear families of NIDDM patients in suggesting polygenic inheritance or environmental influences rather than autosomal dominant inheritance with high penetrance.Abbreviations IGT Impaired glucose tolerance - GTT glucose tolerance test - NIDDM non-insulin-dependent diabetes mellitus - fpg fasting plasma glucose - apg achieved plasma glucose - CIGMA continuous infusion of glucose test - BMI body mass index  相似文献   

9.
Summary Two hundred and four men with impaired glucose tolerance (borderline diabetes) discovered in a screening examination have been observed for five years and repeated tests of glucose tolerance performed. By pre-determined criteria 27 men worsened to diabetes and this metabolic deterioration was not significantly influenced by treatment with carbohydrate restriction with or without a daily dose of 50 mg phenformin. Of the baseline variables measured prior to treatment allocation only the blood glucose values were significantly predictive of ultimate worsening to diabetes.  相似文献   

10.
11.
Summary To study the islet adaptation to reduced insulin sensitivity in normal and glucose intolerant post-menopausal women, we performed a euglycaemic, hyperinsulinaemic clamp in 108 randomly selected women, aged 58–59 years. Of the 20 women with the lowest insulin sensitivity, 11 had impaired glucose tolerance (IGT) whereas 9 had normal glucose tolerance (NGT). These women together with 15 women with medium insulin sensitivity and 16 women with high insulin sensitivity and NGT were further examined with arginine stimulation at three glucose levels (fasting, 14 and >25 mmol/l). In NGT, the acute insulin response (AIR) to 5 g i. v. arginine at all three glucose levels and the slopeAIR, i. e. the glucose potentiation of insulin secretion, were markedly increased in the women with the lowest insulin sensitivity and NGT compared to those with medium or high insulin sensitivity. In contrast, in low insulin sensitivity, AIR was significantly lower in IGT than in NGT (at glucose 14 mmol/l p=0.015, and at >25 mmol/l p=0.048). The potentiation of AIR induced by low insulin sensitivity in women with NGT was reduced by 74% (AIR at 14 mmol/l glucose) and 57% (AIR at >25 mmol/l glucose), respectively, in women with IGT. Also the slopeAIR was lower in IGT than in NGT (p=0.025); the increase in slopeAIR due to low insulin sensitivity was abolished in IGT. In contrast, glucagon secretion was not different between women with IGT as opposed to NGT. We conclude that as long as there is an adequate beta-cell adaptation to low insulin sensitivity with increased insulin secretory capacity and glucose potentiation of insulin secretion, NGT persists.Abbreviations NIDDM Non-insulin-dependent diabetes mellitus - AIR acute insulin response - AGR acute glucagon response  相似文献   

12.
Aims/hypothesis. We hypothesized that beta-cell responses to changes in glucose would not be normal in subjects with impaired glucose tolerance (IGT). Methods. Three groups of 6 subjects were studied: normal weight with normal glucose tolerance (control subjects); obese with normal glucose tolerance (Obese-NGT); and obese with IGT (Obese-IGT). All subjects had a graded glucose infusion protocol to increase (step-up) and then decrease (step-down) plasma glucose. We obtained average insulin-secretion rates (ISR) over the glucose range common to all three groups during step-up and step-down phases, minimal model indices of beta-cell function (fb, fd, fs, Tup, Tdown ), and insulin sensitivity (Si). Results. ISR differed significantly between step-up and -down phases only in Obese-IGT individuals. Basal (fb) and stimulated (fd, fs) beta-cell sensitivity to glucose were similar in the three groups. Delays between glucose stimulus and beta-cell response during both step-up (Tup) and -down (Tdown) phases were higher in Obese-IGT compared to Controls and Obese-NGT individuals. The product ISR × Si (10–5·min–2× l) was lower in Obese-IGT compared to Controls, both during step-up (919 ± 851 vs 3192 ± 1185, p < 0.05) and step-down (1455 ± 1203 vs 3625 ± 691, p < 0.05) phases. Consistently, the product fs× Si (10–14·min–2· pmol–1× l) was lower in Obese-IGT than in control subjects (27.6 ± 25.4 vs 103.1 ± 20.2, p < 0.05). Conclusion/interpretation. Subjects with IGT are not able to secrete insulin to compensate adequately for insulin resistance. They also show delays in the timing of the beta-cell response to glucose when glucose levels are either rising or falling. [Diabetologia (2002) 45: ▪–▪] Received: 30 July 2001 and in revised form: 21 November 2001  相似文献   

13.
AIMS: To determine the effects of rosiglitazone on insulin sensitivity, glucose tolerance and ambulatory blood pressure when administered to subjects with persistent impaired glucose tolerance (IGT). METHODS: Eighteen subjects with persistent IGT were randomized to receive rosiglitazone 4 mg twice daily or matching placebo for 12 weeks. Evaluation at baseline and at the end of treatment included measurement of whole body insulin sensitivity during a euglycaemic hyperinsulinaemic clamp and deriving an insulin sensitivity index. Changes in glucose and insulin concentration were determined after oral glucose tolerance test (OGTT) and mixed meal tolerance tests, and 24-h ambulatory blood pressure was monitored. RESULTS: Rosiglitazone significantly improved the insulin sensitivity index by 2.26 micro g/kg per min per pmol/l relative to placebo (P = 0.0003). Four of nine subjects receiving rosiglitazone reverted to normal glucose tolerance and 5/9 remained IGT, although four of these had improved 2-h glucose values. In the placebo group, 1/9 subjects progressed to Type 2 diabetes and 8/9 remained IGT. Following OGTT and meal tolerance test, glucose and insulin area under curve were reduced over 3 and 4 h, respectively. Compared with placebo, ambulatory blood pressure decreased significantly in the rosiglitazone group by 10 mmHg systolic (P = 0.0066) and 8 mmHg diastolic (P = 0.0126). CONCLUSIONS: Consistent with its effects in patients with Type 2 diabetes, rosiglitazone substantially improved whole body insulin sensitivity and the glycaemic and insulinaemic responses to an OGTT and meal tolerance test in subjects with persistent IGT. Furthermore, rosiglitazone reduced systolic and diastolic ambulatory blood pressure in these subjects.  相似文献   

14.
Aim: Recent data has shown that vitamin D increases insulin sensitivity; however, there is little evidence about the effects of this treatment on elderly people with impaired fasting glucose. The aim of the present study was to investigate the effect of vitamin D treatment on insulin sensitivity and metabolic parameters in elderly people with impaired fasting glucose. Methods: A total of 28 elderly patients were enrolled into the vitamin D treatment group. The control group included 23 age‐, sex‐ and body mass index‐matched elderly participants. The vitamin D treatment group was treated with vitamin D3 according to serum concentrations of 25(OH)D. Results: With supplementation, 96.0% of patients achieved a mean serum 25(OH)D concentration of 123.2 ± 59.9 nmol/L. After 4.7 ± 2.5 months of treatment, there was a significant decrease in homeostasis model assessment of insulin resistance, insulin and glucose concentrations in the vitamin D treatment group (P = 0.007, P = 0.007, P = 0.037, respectively). Vitamin D treatment significantly increased high‐density lipoprotein cholesterol (P = 0.037), but did not cause statistically significant differences in other lipid parameters. Conclusion: We found that vitamin D treatment might modify insulin sensitivity in the elderly with impaired fasting glucose. Geriatr Gerontol Int 2012; 12: 454–460.  相似文献   

15.
Summary The relative importance of insulin resistance and abnormal insulin secretion as risk factors for the development of impaired glucose tolerance (IGT) is controversial. Few prospective data are available on metabolic precursors of IGT. We examined the relation of fasting serum insulin level (as a marker of insulin resistance) and change in insulin/glucose ratio (ΔI 30/ΔG30) over the first 30 min after glucose ingestion (as a marker of insulin secretion) as predictors of the 7-year development of IGT in 839 Mexican Americans and non-Hispanic whites with normal glucose tolerance at baseline from the San Antonio Heart Study. IGT eventually developed in 148 subjects. When modelled separately, fasting serum insulin (odds ratio (OR)=2.60,95 % confidence interval (CI)=1.58,4.28,p<0.005), but not ΔI 30/ΔG30 (OR=0.80, 95 % CI=0.50,1.27,p=0.339) predicted the development of IGT. However, when both variables were included in the same logistic regression model, fasting serum insulin (OR=3.50, 95 % CI=1.97,6.21,p<0.001) and low ΔI 30/ΔG30 (OR=0.48, 95 % CI=0.28,0.82,p=0.008) both predicted IGT. These results were basically unchanged after further adjustment for obesity, body fat distribution and fasting plasma glucose level. We conclude that both decreased insulin secretion (as assessed by low ΔI 30/ΔG30) and increased insulin resistance (as assessed by fasting serum insulin) predict the development of IGT and are thus early precursors of non-insulin-dependent diabetes mellitus; further studies of insulin secretion should take into account the level of basal insulin resistance.  相似文献   

16.
Summary Plasma glucose and insulin concentration following a 75 g oral glucose challenge and glucose uptake during a hyperinsulinaemic glucose clamp study were determined in 50 non-obese individuals. The study population was divided into five groups on the basis of their glucose tolerance: normal, impaired glucose tolerance, Type 2 (non-insulin-dependent) diabetes mellitus with fasting plasma glucose of less than 8 mmol/l, between 8–15 mmol/l, and more than 15 mmol/l. The plasma insulin response was significantly greater (p<0.001) than normal in those with either impaired glucose tolerance or Type 2 diabetes and a fasting plasma glucose concentration less than 8 mmol/l. In contrast, the plasma insulin response was similar to normal in the other two groups of patients with Type 2 diabetes, i.e. fasting plasma glucose concentration 8–15 mmol/l or greater than 15 mmol/l. Glucose uptake rates were significantly lower (p<0.001) than normal in subjects with impaired glucose tolerance and all three groups of patients with Type 2 diabetes. Although glucose uptake rates during the glucose clamp studies were relatively similar in all four groups of glucose intolerant subjects, the values were significantly lower in those patients with Type 2 diabetes who had a fasting plasma glucose concentration greater than 8 mmol/l (p<0.01), These data indicate that a significant degree of insulin resistance exists in patients with impaired glucose tolerance or Type 2 diabetes, relatively independent of fasting plasma glucose concentration. Indeed, glucose uptake during glucose clamp studies fell 8-fold over a range in fasting plasma glucose concentration of from 4.5 to 6.5 mmol/l. In contrast, the plasma insulin response increased over the same range of fasting plasma glucose concentrations. The fact that this defect in insulin action can be seen in patients who are hyperinsulinaemic, not hypoinsulinaemic, and only modestly hyperglycaemic, is consistent with the hypothesis that resistance to insulin-stimulate glucose uptake is a basic characteristic of patients with impaired glucose tolerance or Type 2 diabetes.  相似文献   

17.
AIMS: To estimate the prevalence and the determinants of diabetes mellitus and impaired glucose regulation (IGR) in an adult Canarian population. METHODS: Cross-sectional study. One thousand and thirty subjects aged 30-82 years were randomly selected. Participants completed a survey questionnaire and underwent blood pressure measurements, anthropometry, blood samples, and a 75-g standardized oral glucose tolerance test. RESULTS: The age-standardized prevalence of diabetes was 15.8% (95% confidence interval: 11.8-19.8) in men and 10.6% (7.1-14.1) in women. Total prevalence was 13.2% (11.1-15.2). Among individuals with diabetes, 55.4% of men and 38.2% of women were not previously diagnosed. The age-standardized prevalences of impaired glucose tolerance and impaired fasting glycaemia were 11.4% (9.5-13.4) and 2.8% (1.8-3.8), respectively. In multivariate analyses, age, waist circumference, serum triglycerides, and familial history of diabetes were independently associated with diabetes in both sexes, while a value of C-reactive protein (CRP) >/= 1 mg/l showed an association with diabetes, but only in men. Age and triglycerides were related to impaired glucose regulation (IGR) in both sexes, waist circumference was related to IGR exclusively in men, and familial diabetes exclusively in women. Statistically significant interactions between gender and both CRP and triglycerides were found with respect to diabetes, and between gender and both waist circumference and triglycerides for IGR. CONCLUSIONS: Compared with the rest of Spain, the prevalence of diabetes is moderately increased in this area of the Canary Islands. Along with other well-established risk factors, CRP was independently associated with diabetes, but only in the male population.  相似文献   

18.
Pratley RE  Weyer C 《Diabetologia》2001,44(8):929-945
Patients with Type II (non-insulin-dependent) diabetes mellitus manifest abnormalities in insulin action and insulin secretion. It is widely accepted that insulin resistance is an early finding, evident before the onset of hyperglycaemia and predictive of the subsequent development of diabetes. Whether abnormalities in insulin secretion also precede and predict diabetes has been debated. However, recent studies clearly indicate that early insulin secretion plays a critical role in maintaining normal glucose homeostasis. Cross-sectional analyses show that acute insulin secretory responses (AIR) to intravenous glucose are lower in subjects with impaired glucose tolerance and those at high risk for developing diabetes. Prospectively, a low AIR predicts the development of diabetes in several populations. In longitudinal studies, AIR declines dramatically as patients progress from normal to impaired glucose tolerance and ultimately to diabetes. Early insulin secretion is important for the rapid and efficient suppression of endogenous glucose production after a meal. Thus, loss of early insulin secretion initially leads to post-prandial hyperglycaemia which, as the disease progresses, worsens to clinical hyperglycaemia. Strategies that enhance early insulin secretion improve glucose tolerance and represent a novel and more physiologic approach to improving glycaemic control in patients with Type II diabetes mellitus. [Diabetologia (2001) 44: 929–945] Received: 27 December 2000 and in revised form: 8 April 2001  相似文献   

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20.
AIMS: To investigate the effects of atorvastatin on glucose homeostasis, the basal and postprandial lipid profiles and the CRP levels (C reactive protein) in subjects with impaired fasting glucose (IFG). METHODS: Thirty-three subjects (22 men and 11 women) were included in our study. All displayed an IFG (fasting plasma glucose between 6.1 and 7.0 mmol/l) on at least two occasions during the last 6 months prior the study. They were randomly assigned to receive either 40 mg atorvastatin/day (n=16) or placebo (n=17) over 16 weeks, in a double-blind design. Before and after the end of the study all participants underwent on three consecutive days: a 75-g oral glucose tolerance test, a frequent sampling intravenous glucose tolerance test with Minimal Model analysis and a meal tolerance test (glucose, insulin and triglycerides). CRP was measured before and after the treatment period. RESULTS: CRP decreased significantly in the atorvastatin-treated group compared with the placebo group (percent change respect initial values; -42.3 %[-21.5 to - 63.1] and -9.6%[15.0 to -34.0], respectively, p<0.01). Atorvastatin treatment did not produce any change in oral glucose tolerance categories or induce any change in glucose and insulin response in OGTT. The statin produced a trend towards a significant improvement in insulin sensitivity as expressed by a change in Si from baseline to the end of treatment. Atorvastatin reduced the postprandial response of triglycerides to the meal test compared with placebo (19-26 % across the meal test, p<0.05) correlating with the amelioration observed in Si (-0.34, p<0.05; percentage changes). CONCLUSION: Our results suggest that the use of statins in subjects with IFG seems to include other potentially beneficial actions in addition to their cholesterol-lowering effects.  相似文献   

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