空腹血糖异常人群胰岛素分泌功能及胰岛素抵抗状态的探讨

目的　探讨空腹血糖异常人群的胰岛素分泌及胰岛素抵抗状态。　方法　选择包钢糖尿病普查中复查口服葡萄糖耐量试验 (OGTT) 3985例 ,分为 6组 :正常糖耐量 (NGT)组 2 5 88例 ,异常空腹血糖 (IFG)组 2 72例 ,糖耐量减低 (IGT)组 4 4 9例 ,空腹血糖异常伴糖耐量减低 (IFG/ IGT)组116例 ,新诊断糖尿病 (DM1)组 338例 ,已知糖尿病 (DM2 )组 2 2 2例。测腰围、体重指数、血压、血脂及血浆胰岛素 ,应用稳态模式胰岛素抵抗指数 (HOMA- IR)作为胰岛素抵抗指标 ,稳态模式胰岛 β细胞功能指数 (HBCI)及胰岛素分泌指数 (IS)作为胰岛素分泌指标 ,并对 6组患者的这些指标及临床特征 ,进行对比分析。　结果　与 NGT组比较 ,IFG组 HOMA- IR(1.4 6± 0 .6 0 ,1.0 6± 0 .6 4 ,t=- 6 .716 ,P<0 .0 0 1)、空腹胰岛素 (FINS) (17.90± 10 .0 6 ,15 .79± 10 .94 ,t=- 2 .0 71,P=0 .0 39)增高 ,HB-CI(4.6 5± 0 .6 0 ,5 .2 7± 0 .76 ,t=3.399,P<0 .0 0 1)及 IS(0 .86± 0 .6 0 ,0 .99± 0 .6 2 ,t=2 .36 6 ,p=0 .0 18)降低 ;IGT组 HOMA- IR(1.39± 0 .5 8,t=4 .6 98) ,FINS(2 1.2 7± 15 .39,t=4 .4 93)、2 - h胰岛素(6 0 .84± 37.86 ,t=8.4 82 )、HBCI(5 .4 7± 0 .79,t=2 .6 98)、IS(1.2 5± 0 .6 1,t=4 .0 34,P值均 <0     

Insulin resistance and metabolic syndrome criteria in lean,normoglycemic college-age subjects

Aims

The goal of this study was to determine insulin sensitivity in a fasted state and during an oral glucose tolerance test (OGTT), in normoglycemic (NGT), lean (L) (n?=?35) and, for comparison, overweight/obese (OW/O) (n?=?9) college-aged subjects.

The metabolic syndrome predicts cardiovascular events in subjects with normal fasting glucose: results of a 15 years follow-up in a Mediterranean population

The aim of this study was to evaluate the cardiovascular (CV) risk due to the metabolic syndrome in a 15-year prospective study of a Sicilian population. In the Mediterranean area obesity is highly prevalent, but epidemiological data on the metabolic syndrome are limited. METHODS AND RESULTS: Among the 1351 subjects enrolled in the "Ventimiglia di Sicilia" epidemiological project, we selected 687 subjects between 35 and 75 years of age; baseline parameters were assessed and subjects have been followed for 15 years recording CV events, total and cardiovascular mortality. The metabolic syndrome was defined according to both the Adult Treatment Panel III and the International Diabetes Federation criteria. Metabolic syndrome (ATPIII criteria) was significantly (p<0.00001) more prevalent in women (31.5%) than in men (12.4%). The metabolic syndrome increased the risk of CV events with a hazard ratio of 1.9 (confidence interval CI; 1.46-2.46). Using a Cox proportional hazards estimation model, the survival curve of subjects with metabolic syndrome and normal fasting glucose did not significantly differ from the curve of subjects with metabolic syndrome and impaired fasting glucose (IFG). CONCLUSIONS: In a 15-year follow-up the metabolic syndrome is predictive of CV events regardless of the presence of IFG or diabetes mellitus.     

Moderate alcohol consumption is associated with impaired insulin secretion and fasting glucose in non-obese non-diabetic men

Aims/IntroductionA low insulin secretion capacity has been implicated in the high prevalence of non‐obese diabetes in East Asians. As alcohol consumption alters insulin and glucose metabolism, we tested the hypothesis that alcohol consumption contributes to impaired insulin secretion and glucose intolerance in lean/normal‐weight non‐diabetic Japanese men.Materials and MethodsThis cross‐sectional study was undertaken among the residents of Shika town, Japan, between 2011 and 2017. A total of 402 non‐diabetic men, including participants with normal fasting plasma glucose (FPG) and impaired FPG (FPG 5.6–6.9 mmol/L), and aged ≥40 years, were examined. FPG, the homeostasis model assessment of insulin secretion capacity (HOMA‐B) and alcohol consumption were evaluated and compared between the body mass index (BMI) <25 and BMI ≥25 groups.ResultsHOMA‐B levels were lower in the BMI <25 group than in the BMI ≥25 group. Alcohol consumption correlated with a low HOMA‐B level regardless of BMI, and, thus, the HOMA‐B levels of alcohol drinkers were significantly lower in the BMI <25 group. A multivariable logistic regression analysis showed that alcohol consumption, even light‐to‐moderate consumption (1–25 g/day), was associated with significantly low levels of HOMA‐B and impaired FPG in the BMI <25 group. Among participants with impaired FPG, a low level of HOMA‐B was observed in alcohol drinkers, but not in non‐drinkers. In contrast, light‐to‐moderate alcohol consumption was not related to HOMA‐B or FPG in the BMI ≥25‐group.ConclusionAlcohol consumption, even a small amount, might contribute to reductions in HOMA‐B levels and impaired FPG in lean/normal‐weight Japanese men.     

糖调节受损个体胰岛β细胞功能和胰岛素抵抗观察

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.     

Glucose variability in subjects with normal glucose tolerance: Relations with body composition,insulin secretion and sensitivity

Background and aimsTo estimate the determinants of glucose variability (GV) in young and middle-aged non-obese subjects with normal glucose tolerance (NGT) we assessed relations between GV parameters, body composition, insulin secretion and sensitivity indices.MethodsThirty individuals with normal body mass index (BMI) and twenty overweight subjects were included. 24-hour mean glucose, time in range, time above range (TAR), time below range (TBR), standard deviation (SD), coefficient of variation (CV), mean amplitude of glucose excursions (MAGE), continuous overlapping net glycemic action (CONGA), J-index, lability index (LI), mean absolute glucose (MAG), M-value, high blood glucose index (HBGI), low blood glucose index (LBGI) were derived from continuous glucose monitoring. Body composition was assessed by DEXA. Insulin secretion and sensitivity was estimated by HOMA-IR and HOMA-B scores.ResultsOverweight subjects demonstrated higher mean glucose, CONGA, J-index and lower TBR, M-value and LBGI values. Mean glucose correlated positively with total, trunk, gynoid and android fat mass, while M-value and LBGI demonstrated negative correlations with these parameters. In multiple stepwise regression analysis, android fat mass was a predictor of mean glucose, CONGA, J-index, SD and MAGE, gynoid fat mass predicted J-index only, and total fat mass was associated inversely with MAG. Fasting insulin was a predictor of TAR, SD, CV, MAGE, MAG, LI and HBGI. HOMA-B was associated with CONGA, M-value and LBGI.ConclusionIn non-obese subjects with NGT mean glucose and GV parameters are related to fat mass and fat distribution. These relations can be mediated through insulin secretion and sensitivity.     

Feedback inhibition of insulin and glucagon secretion by insulin is altered in abdominal obesity with normal or impaired glucose tolerance

We investigated the feedback inhibition of insulin and glucagon secretion during euglycemic-hyperinsulinemic clamp at about 350 pmol/l in 16 patients with abdominal obesity [8 with normal glucose tolerance (oNGT), 8 with impaired glucose tolerance (oIGT)] and 8 normal-weight subjects matched for age, sex and blood pressure. In oNGT and oIGT, fasting plasma C-peptide levels were twice those in the controls (962±51 and 915±85 vs 439±28 pmol/l,P<0.001) and their suppression was lower than in the controls, both in absolute terms (155±19 and 185±17 vs 274±18 pmol/l,P<0.001) and as a percentage decline from basal levels (16±2% and 21±2% vs 63±2%,P<0.001). Fasting plasma glucagon levels were similar in the patients and in the controls, but were less suppressed during clamp in oNGT and oIGT, both in absolute terms (7.0±0.9 and 5.6±0.6 vs 13.2±1.2 pmol/l,P<0.001) and as a percentage change from basal levels (23±3% and 19±2% vs 44±4%,P<0.001). These results suggest that the insulin feedback on B and A cells is impaired in abdominal obesity, and that this defect is of similar degree in oNGT and oIGT. These alterations could be implicated in the pathogenesis of hyperinsulinemia in obesity.     

胰岛素抵抗指数在不同糖耐量人群中诊断代谢综合征的作用

目的探讨胰岛素抵抗指数(HOMA-IR)在不同糖耐量人群中诊断代谢综合征(MS)的作用。方法15568名≥25岁的经口服75g葡萄糖耐量试验的人群被分为糖耐量正常(NGT)组、糖调节受损(IGR)组、新诊断糖尿病(DM)组。MS诊断根据1999年WHO定义，其中胰岛素抵抗(IR)采用胰岛素抵抗指数(HOMA-IR)判断。结果(1)10147名25～74岁NGT人群的HOMA-IR值上1／4位点为2．69。MS、IGR、DM、IR患病率(2000年中国人口年龄标化后)分别为59．0％、19．58％、25．28％和29．22％。在IGR DM组中MS人群伴发IR的频率为45．30％。(2)Logistic回归分析显示：HOMA-IR在NGT组与MS发生有关，在IGR DM和总组中与MS发生无关。与MS发生相关性最强的是腰／臀围比和血压。各方程预测MS发生的一致性高达90％以上(P均=0．0001)。结论HOMA-IR诊断MS的作用并不适宜于所有人群，在高血糖人群中不是一个灵敏的指标。在NGT人群中诊断MS，HOMA-IR判定IR可以作为一个简易、准确的指标。但在高血糖人群中诊断MS，IR的评估应该综合判断。     

中心性肥胖正常糖调节人群中不同胰岛素敏感性者的代谢特征及脂联素水平

腰围匹配的中心性肥胖正常糖调节人群,不同胰岛素敏感性组间随着胰岛素抵抗的加重,收缩压、血清甘油三酯、空腹及餐后血糖逐渐升高,代谢综合征(MS)的构成比也随之升高;血清脂联素水平随胰岛素抵抗的加重而降低;此外,MS与非MS者间血清脂联索差异也有统计学意义(P<0.01)。     

罗格列酮对非糖尿病代谢综合征患者糖脂代谢、胰岛素抵抗及炎症指标的影响

157名伴有低HDL-C和代谢综合征（MS）的非糖尿病患者随机分为两组,分别给予马来酸罗格列酮4mg或8mg／d治疗12周之后,两组FPG、2hPG、HbA1C、Fins、HOMA—IR、TG、hsC—RP、纤维蛋白原（FIB）和WBC均下降,HDL-C升高（P均＜0．05）,8mg组变化尤著;两组TC和LDL-C均无明显变化（P〉0．05）。对伴有低HDL—C和MS的非糖尿病患者予罗格列酮治疗能有效改善血糖和血脂,减轻IR和炎症状态。     

对胰岛素抵抗在代谢综合征中作用的新认识

代谢综合征(MS)是以中心性肥胖、高血压、脂质代谢异常、微量蛋白尿、葡萄糖耐量受损和(或)糖尿病等为特征的一组临床综合征,是导致糖尿病、心脑血管疾病的危险因素。1999年WHO将其正式命名为MS,并做了工作定义。2005年国际糖尿病联盟(IDF)对其提出了新的工作定义,进而达成全球共识。胰岛素抵抗是指机体对一定量胰岛素的生物学反应低于预计正常水平的一种现象,是导致MS发病的主要机制,其与MS各组分之间密切相关,但机制尚未完全阐明。本文就MS的定义及有关胰岛素抵抗在MS发生中的作用机制的研究的新进展做简要综述。     

Elevated fasting insulin is associated with cardiovascular and metabolic risk in women with polycystic ovary syndrome

AimsPCOS is associated with various immediate and long term health complications. The aim of this study was to investigate the association of serum fasting insulin concentration with cardiovascular and metabolic risk factors in women with polycystic ovary syndrome.MethodsA total of 349 women, 249 women with polycystic ovary syndrome and 100 age-matched healthy controls, were recruited in this case-control study. Fasting insulin and various other biochemical, hormonal and clinical parameters were measured in all participants. The correlation of insulin with cardiometabolic risk factors was evaluated in PCOS women with normal and high serum insulin concentration.ResultsFasting Insulin, BMI, WHR, FAI, LH: FSH, HOMA, QUICKI were significantly higher in PCOS women compared with healthy controls (p < 0.01). Fasting insulin showed a positive correlation with more cardiovascular and metabolic risk factors in PCOS compared to controls. The BMI, BAI, LAP, HOMA IR, QUICKI and FAI were significantly higher (all p < 0.05) in PCOS patients with higher insulin levels than with PCOS women with normal levels.ConclusionFasting insulin is an important determinant in the pathogenesis of obesity and hyperandrogenism in PCOS. It is associated with an increased risk of cardiovascular and metabolic disorders in women with PCOS.     

新疆汉、维民族糖调节受损人群胰岛素分泌功能和胰岛素作用功能的研究

目的 评估新疆汉、维民族在IFG,IGT及IGR阶段的胰岛素分泌功能和胰岛素作用功能。 方法 采用多中心研究进行横断面调查,行OGTT试验。用胰岛素抵抗指数（HOMA-IR）评估IR,胰岛β细胞功能指数（HOMA-β）评估基础胰岛素分泌;ΔI30/ΔG30评价胰岛素早相分泌,ΔI30/ΔG30/HOMA-IR评估葡萄糖处置指数（DI）。 结果 WC、BMI、血脂、FIns、2 hIns在汉、维民族不同糖代谢组差异有统计学意义。IFG组与NGT、IGT组比较,汉、维族人群的HOMA-IR差异有统计学意义。在汉族中NGT组与IGT、IGR组比较,HOMA-β差异有统计学意义（P=0.030、0.044）,而在维族只有IFG组与NGT组比较差异有统计学意义（P=0.001）。ΔI30/ΔG30、DI在两民族不同糖代谢组差异均无统计学意义。 结论 汉族人群IR在IFG阶段,胰岛素分泌功能在IGT阶段起主要作用。IR和胰岛素分泌功能在维族人群IFG阶段起重要作用。胰岛素早相分泌及葡萄糖处置功能在糖调节受损阶段作用不显著。     

罗格列酮对合并空腹血糖正常代谢综合征的急性冠脉综合征患者部分炎症因子的影响

目的:探讨罗格列酮对空腹血糖正常的代谢综合征(MS)的急性冠脉综合征(ACS)患者体内部分炎症水平的影响。方法:30例合并空腹血糖正常的MS的ACS患者,随机被分为对照组(A组,按常规治疗)和罗格列酮组(B组,常规治疗 罗格列酮治疗),疗程均为4周。治疗前、后分别测定空腹血糖,血清总胆固醇(TC),低密度脂蛋白-胆固醇(LDL-C),高敏C反应蛋白(hs-CRP),肿瘤坏死因子α(TNF-α)和白介素6(IL-6)水平。结果:治疗4周后,治疗组空腹血糖,空腹胰岛素,血清hs-CRP、TNF-α水平均明显降低(P<0.05~<0.01),且较对照组更显著(P<0.05~<0.01)。结论:罗格列酮可减少粥样硬化斑块炎症反应,使合并空腹血糖正常的代谢综合征的急性冠脉综合征患者受益。     

非酒精性脂肪肝:代谢综合征的另一个特征

目的　分析非酒精性脂肪肝 (NAFL)临床及生化特征 ,以探讨NAFL可否成为代谢综合征的一个组成部分。方法　对 85例NAFL患者测体重指数、腰臀比、空腹血糖、血脂、胰岛素、餐后 2h血糖和胰岛素抵抗指数。以 43例非脂肪肝的体检者为对照组。结果　 1.在NAFL患者中 ,中心性肥胖占 70 .5 9% ,高血压病占 3 1.77% ,高TG血症占 62 .3 5 % ,低HDL C占 3 6.47% ,均明显高于对照组 (P <0 .0 0 5～ 0 .0 1) ,而DM/IGT/IPG的患病率 ,两组相比无明显差异 ;2 .血清FINS水平和IR脂肪肝组也较对照组明显增加 (P <0 .0 1) ;3 .在 12 8例研究对象中 ,有 2 1例患者患有代谢综合征 ,其中脂肪肝者占 85 .71% ,中心性肥胖者占 90 .48% ,高血压者占 76.19% ,血脂紊乱者占 10 0 % ,DM/IGT/IPG者占 3 8.10 %。结论　NAFL患者存在明显的胰岛素抵抗 ,可作为代谢综合征的一个组成部分。     

Resistin is not associated with insulin sensitivity or the metabolic syndrome in humans

Aims/hypothesis The aim of this study was to further elucidate the relationship between resistin and insulin sensitivity, body fat distribution and the metabolic syndrome in humans.Methods We measured plasma resistin levels in 177 non-diabetic subjects (75 male, 102 female; age 32–75 years). BMI, waist circumference, blood pressure, lipids, glucose, plasminogen-activator inhibitor 1 (PAI-1), adiponectin and leptin levels were also measured. The insulin sensitivity index (S_I) was quantified using Bergmans minimal model. Intra-abdominal fat (IAF) and subcutaneous fat (SQF) areas were quantified by CT scan. Presence of metabolic syndrome criteria was determined using the National Cholesterol Education Program Adult Treatment Panel III guidelines.Results When subjects were divided into categories based on BMI (< or 27.5 kg/m²) and S_I (< or 7×10^–5 min^–1 [pmol/l]^–1), resistin levels did not differ between the lean, insulin-sensitive (n=53, 5.36±0.3 ng/ml), lean, insulin-resistant (n=67, 5.70±0.4 ng/ml) and obese, insulin-resistant groups (n=48, 5.94±0.4 ng/ml; ANOVA p=0.65). Resistin correlated with age (r=–0.22, p<0.01), BMI (r=0.16, p=0.03) and SQF (r=0.19, p=0.01) but not with S_I (p=0.31) or IAF (p=0.52). Resistin did not correlate with the number of metabolic syndrome criteria or any of the individual metabolic syndrome criteria. In contrast, adiponectin, PAI-1 and leptin each correlated with IAF, SQF and S_I. Additionally, the number of metabolic syndrome criteria correlated with adiponectin (r=–0.32, p<0.001), leptin (r=0.31, p<0.001) and PAI-1 (r=0.26, p=0.001).Conclusions/interpretation In contrast to other adipokines, resistin is only weakly associated with body fat and is unlikely to be a major mediator of insulin resistance or the metabolic syndrome in humans.     

Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance

The aim of this study was to investigate cross-sectionally the prevalence and covariates of obstructive sleep apnea syndrome (OSAS) and its relationship to metabolic syndrome (MS), insulin resistance (IR), and coronary heart disease (CHD) in a population sample of 1,946 men and women representative of Turkish adults. OSAS was identified when habitual snoring and episodes of apnea were combined with another relevant symptom. MS was diagnosed based on modified criteria of the Adult Treatment Panel III and IR by homeostatic model assessment (HOMA). OSAS was identified in 61 men (6.4%) and 58 women (5.8%), at a similar prevalence, after adjusting for covariates. Among individuals with OSAS, significantly higher odds ratios (ORs), adjusted for age, body mass index (BMI), and waist girth, were observed for MS, hypertension, and prevalent CHD, but not for HOMA or menopause. Significantly higher C-reactive protein existed only in women with OSAS who were also more frequent smokers. In logistic regression models, waist circumference, but not BMI nor hypertension, was significantly associated with OSAS among men. In women, by contrast, current cigarette smoking and hypertension were the significant independent covariates. Regression models controlling for sex, age, and smoking revealed that MS (and not IR per se) was associated significantly with OSAS (OR 1.94) in nondiabetic individuals. To conclude, abdominal rather than overall obesity in men and smoking among women are significant independent determinants of OSAS in Turkish adults. OSAS is associated with MS rather than IR per se. Relatively high prevalence of OSAS is observed in Turkish women in whom it is significantly associated with CHD.     

基础及早期胰岛素分泌对2型糖尿病患者血糖水平的贡献

目的　探讨 2型糖尿病人群基础及早期胰岛素分泌对血糖水平的贡献。方法　 2型糖尿病患者 81例 ,测定标准餐试验 0、3 0、60、12 0min血浆葡萄糖及真胰岛素水平。计算胰岛素敏感性指数 (ISI)和早期胰岛素分泌 (ΔI3 0 /ΔG3 0 ) ,以评估机体胰岛素敏感性 ,以多因素回归方法评估早期及基础胰岛素分泌对2型糖尿病人群血糖变化的贡献。结果　多因素回归分析显示 ,ISI和ΔI3 0 /ΔG3 0 对血糖变化的贡献几乎相等。在标准餐试验各时点胰岛素值中 ,空腹及 60min血浆真胰岛素水平对血糖水平的变化起主要作用 ;空腹胰岛素对血糖曲线下面积的作用强于ΔI3 0 /ΔG3 0 的作用。结论　基础及早期胰岛素分泌对血糖水平的变化都有重要影响