单纯空腹血糖受损和单纯空腹高血糖型糖尿病的代谢特征

目的评估初发的单纯空腹血糖受损（iIFG）和单纯空腹高血糖型糖尿病（IFH）患者的胰岛素分泌及胰岛素敏感性特征,进一步探讨进展为IFH的相关因素。方法2004—2005年瑞金医院内分泌科门诊初诊病人,隔夜空腹10h后行口服葡萄糖耐量试验,其中同时行胰岛素释放试验1852例。其中糖耐量正常（NGT）557例;iIFG221例;IFH81例。比较各组的代谢指标及胰岛素分泌和胰岛素敏感性指数。结果对1852例接受者操作特征曲线（ROC）分析确定的糖耐量异常（除外糖尿病）发生的最佳空腹血糖切点为5．590mmol／L,2型糖尿病发生的最佳空腹血糖切点为6．695mmol／L。从NGT→iIFD→IFH,早期相胰岛素分泌和胰岛素敏感性指数均逐渐降低。结论初发的iIFG和IFH均有显著的早期相胰岛素分泌缺陷和胰岛素敏感性降低。B细胞胰岛素分泌缺陷和胰岛素抵抗均是从NGT向iIFG向IFH的进展过程中的重要因素。     

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     

2型糖尿病患者空腹血糖水平变化与真胰岛素的相关性研究

目的探讨2型糖尿病(DM)患者空腹血糖(FPG)的水平变化是否与真胰岛素(TI)有关;2型DM患者TI受血糖影响与TI真实水平的依据。方法正常对比组100例,2型DM组200例。将这200患者中空腹血糖的浓度范围6.0~10 mmol/L间137例划为A组,浓度>10 mmol/L的63例划为B组。300例相关人员均与早晨空腹采集3mL静脉血送检测,FPG用全自动的生化分析仪测,真胰岛素用化学发光免疫的分析法(CLIA)检测。精密的操作以保证结果的准确性。结果 2型DM患者真胰岛素浓度(34.56±20.51)p mol/L;正常对比组真胰岛素浓度(33.00±19.05)p mol/L。2型DM患者中A组的TI浓度(36.00±24.57)p mol/L;B组的TI浓度(39.51±23.46)p mol/L。各组间并没有统计学的意义(P>0.05)。对2型DM组FPG和TI统计,其相关的系数r=0.0056,回归方程是Y=35.998+0.038X,FPG与TI的浓度是正相关。结论 2型DM患者TI浓度会随FPG的浓度上升而上升,两者呈正直线相关。证实2型糖血糖可以调节2型DM患者的空腹胰岛素,所以对2型糖尿病患者而言维持着血糖的稳定是必要的。     

健康体检者空腹血糖、胰岛素抵抗与血清谷氨酰转肽酶水平的相关性研究

目的 探讨健康体检者血清谷氨酰转肽酶（γ-GT）与FPG、IR间的关系. 方法 纳入793名健康体检者,根据FPG中位数5.42 mmol/L与胰岛素抵抗指数（HOMA-IR）中位数2.04,分为高FPG（HF）组和正常FPG（NF）组,IR组和IS组,比较各组γ-GT水平. 结果 HF、IR组γ-GT水平均高于NF、IS组（P＜0.01）.Spearman相关分析显示,γ-GT与FPG、FIns及HOMA-IR呈正相关.Logistic回归分析结果显示,FPG（OR=1.615,95％CI：1.208～2.158）、TG（OR=4.104,95％CI：2.650～6.357）、FIns（OR=2.866,95％CI：1.114～7.372）及饮酒情况（OR=3.068,95％CI：1.935～4.864）是γ-GT水平升高的危险因素. 结论 FPG、FIns与血清γ-GT水平相关,γ-GT可能成为T2DM发生风险的预测因素.     

应用动态血糖监测及高胰岛素-正糖钳夹技术评价地特胰岛素对2型糖尿病患者的疗效及安全性

目的 应用动态血糖监测（CGM）、高胰岛素-正糖钳夹技术以及静脉葡萄糖耐量试验（IVGTT）评价口服降糖药控制不佳的2型糖尿病患者加用地特胰岛素皮下注射的疗效、安全性以及对血糖波动、病理生理功能的影响.方法选取2010年3月至8月于大连市中心医院就诊的20例口服降糖药控制不佳的2型糖尿病患者（均符合1999年WHO糖尿病诊断标准）,在原有治疗方案的基础上加用地特胰岛素（6~8）U/d起始治疗,治疗期为3个月,治疗前后分别应用动态血糖监测技术及高胰岛素-正糖钳夹技术以及IVGTT评估患者的血糖波动、胰岛素敏感性以及第1时相胰岛素分泌的情况,测定20例患者治疗前后基线身高、体重、腰围、臀围、肝肾功能、血糖、血脂、胰岛素及C肽、糖化血红蛋白（HbA1c）等指标,同时比较治疗前后的相关指标.正态分布的计量资料比较采用t检验,非正态分布的计量资料采用秩和检验;相关分析采用Pearson相关及多元线性回归分析.结果 经过3个月的治疗,患者HbA1c、腰臀比、总胆固醇、低密度脂蛋白胆固醇较前明显下降[分别为（8.8±1.6）%,（7.6±1.3）%,t=4.830,P〈0.001;0.95 ± 0.04,0.94 ± 0.04,t=2.317,P〈0.05;（5.1±0.6）mmol/L,（4.5±0.9）mmol/L,t=3.459,P〈0.01;（3.2±0.8） mmol/L,（2.6±0.8） mmol/L,t=3.822,P〈0.01].治疗后正糖钳夹中葡萄糖利用率较前明显升高[（3.9 ±2.1）mg·min^-1·kg^-1,（5.0±2.4） mg·min^-1·kg^-1,t=-2.269,P〈0.05].采用IVGTT刺激后的急性胰岛素反应反映第1时相,治疗后AIR较前有所恢复,但差异无统计学意义.治疗后动态血糖监测显示的平均血糖波动幅度较前明显下降[（7.3±2.4）mmol/L,（5.4±2.9）mmol/L,t=2.279,P〈0.05],而日间平均血糖绝对差治疗前后差异无统计学意义（P〉0.05）.治疗期间无严重低血糖发生.结论 口服药控制不佳的2型糖尿病加用地特胰岛素治疗,在有效地控制血糖的同时,能减轻血糖波动,改善胰岛素敏感性.     

ADA新的空腹血糖受损血糖切点值在老年人群中应用的分析

近年对代谢综合征（metabolic syndrome，MS）以及对胰岛素抵抗综合征（insulin resistance syndrome，IRS）的定义中，血糖代谢异常都是其重要特征。这些定义对于空腹血糖（FBG）正常值的切点（cutpoint）都采用了美国糖尿病协会（ADA）1997年提出的6、1mmol/L（110mg／L）标准，中国糖尿病学会也于1999年10月采用了这一标准。随着近年来糖尿病研究的进展，ADA糖尿病诊断与分类专家委员会于2003年底再次对糖尿病的诊断提出了新的建议，其中最重要的观点就是建议将空腹血糖受损（IFG）的FBG切点值从6、1mmol/L降为5．6mmol/L（100mg／L）。     

空腹血糖受损的老年人群胰岛素抵抗与胰岛β细胞功能研究

目的探讨在空腹血糖为5.6～6.9 mmol/L的诊断标准下,空腹血糖受损(IFG)的老年人群(≥60岁)胰岛素抵抗(IR)与胰岛β细胞功能特点。方法选取正常糖耐量(NGT)者71例,单纯性空腹血糖受损(I-IFG)者65例,单纯性糖耐量受损(I-IGT)者59例,空腹血糖受损 糖耐量受损(IGT IFG)者50例。分别以HOMA IR(HOMA-IR)指数和HOMA-β细胞功能指数(HBCI)评价IR和胰岛β细胞功能。结果经调整,性别、年龄和BMI后分析显示,I-IFG组和IFG IGT组的HOMA-IR均高于NGT组(P<0.05);NGT组与IGT组两组以及I-IFG、I-IGT和IGT IFG三组间的差异无统计学意义(P>0.05)。经调整,性别、年龄、BMI和HOMA-IR后分析显示,I-IFG组和IGT IFG组的HBCI明显低于NGT组和IGT组(P<0.05);而NGT和IGT组间差异无统计学意义(P>0.05)。结论在空腹血糖为5.6～6.9 mmol/L的诊断标准下,老年人I-IFG仍是不同于IGT的一种糖调节受损人群,I-IFG的主要发生机制可能为基础状态下IR与胰岛β细胞功能缺陷。     

关于睡前注射中效胰岛素治疗空腹高血糖的问题

有些糖尿病病人白天用口服降糖药或胰岛素，可以满意控制餐后血糖而空腹血糖控制不好，对此一般采用于睡前加注一次中效胰岛素，常可达到满意控制的效果。但在决定是否睡前加用中效胰岛素之前，应测夜间零点以后的血糖，以确定空腹血糖高究竟系夜间低血糖所致的Ｓｏｍ ｏｇｉ反应还是黎明现象至关重要。下面摘登金世鑫医师等来信，旨在借此引起临床医师们的注意     

一天一次地特胰岛素控制空腹血糖的疗效和安全性评价

FPG对糖尿病患者整体血糖水平和心脑血管糖尿病并发症的防治都至关重要。地特胰岛素（Det）是一种长效基础胰岛素,降糖作用持久且平稳。一天一次Det能有效控制FPG,还能降低治疗中的个体变异性。与中效人胰岛素和长效甘精胰岛素（Gla）相比,Det治疗的患者有较低的低血糖发生率和较少的体重增加。鉴于其优良的疗效和安全性,一天一次Det治疗不受体重和年龄的限制,适应证广泛,是控制FPG的理想选择。     

关于应用基础胰岛素控制空腹高血糖的问题

空腹高血糖发生原因主要有:(1)基础胰岛素分泌和敏感性减低;(2)黎明现象;(3) Somogyi反应。睡前皮下注射中效胰岛素(NPH)或长效甘精胰岛素(Glargine)可改善空腹高血糖,消除后半夜高血糖抑制胰岛素分泌和胰岛素敏感性的“糖毒”作用。现报告1例空腹高血糖的诊治情况如下。患     

Comparison of insulin sensitivity measures in South Asians

Objective

South Asians have increased visceral adiposity, insulin resistance and greater prevalence of type 2 diabetes and cardiovascular disease when compared to Caucasians of European origin. Surrogate markers of insulin resistance such as the composite insulin sensitivity (Matsuda) index correlate with glucose clamps in other populations, but ethnicity can affect these indices. We compared the Matsuda index, homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and triglyceride/HDL ratio to insulin sensitivity derived from euglycemic clamps in healthy South Asians and Caucasians.

Materials/Methods

Twenty-three healthy South Asians and 18 Caucasians matched for age (mean ± SE = 33.6 ± 2.1 vs. 36.0 ± 3.0 years) and BMI (25.2 ± 1.1 vs. 24.6 ± 0.9 kg/m²) underwent 75 g oral glucose tolerance test (OGTT), 2-h euglycemic hyperinsulinemic clamp (240 pmol · m^− 2 · min^− 1), fasting lipid profile, and anthropometric measures.

Results

South Asians had higher fasting insulin (41 ± 5 vs. 21 ± 2 pmol/l; p = 0.002) and lower HDL-C (1.25 ± 0.06 vs. 1.56 ± 0.10 mmol/l; p = 0.010), but similar fasting glucose (5.0 ± 0.1 vs. 4.9 ± 0.1 mmol/l) levels vs. Caucasians. South Asians had significantly decreased measures of insulin sensitivity derived from both the euglycemic clamp (24.9 ± 1.3 vs. 41.4 ± 1.9 μmol · kg^− 1 · min^− 1; p < 0.0001) and OGTT (Matsuda Index 7.60 ± 0.99 vs. 13.60 ± 1.79; p = 0.004). The Matsuda index correlated highly with clamp insulin sensitivity in South Asians (r = 0.50; p = 0.014) and Caucasians (r = 0.47; p = 0.046). HOMA-IR, QUICKI, and triglyceride/HDL ratio correlated with clamp values in South Asians, but not in Caucasians.

Conclusions

In South Asians, Matsuda index, HOMA-IR, QUICKI, and triglyceride/HDL ratio offer simple and valid surrogate measures of insulin sensitivity that can be employed in larger clinical or epidemiological studies in this ethnic group.     

Surrogate index for insulin sensitivity composed of factors not using glucose and insulin in Japanese patients with diabetes

Introduction: The aim of the present study is to propose a novel index of insulin sensitivity instead of homeostasis model assessment of insulin resistance (HOMA‐IR), which has a fundamental limitation of validity when applied to subjects with lower insulin secretions or high fasting plasma glucose (FPG) levels. Materials and Methods: A total of 25 apparently healthy subjects and 24 patients with type 2 diabetes participated in the study. We assessed relationships of glucose infusion rate (GIR), obtained by using the euglycemic hyperinsulinemic glucose clamp technique, with other measurements of metabolic and anthropometric parameters. Results: In multiple regression analysis, a model including log‐transformed (log) triglyceride/log high‐density lipoprotein cholesterol and waist circumference as predictive variables showed the strongest contribution rate to explain GIR as an outcome variable (R² = 0.710). The validity of estimated GIR (EGIR) calculated from the regression equation composed of these factors was further tested in another group of patients including type 1, type 2 and pancreatic diabetes in whom HOMA‐IR could not be used as a result of either high FPG or low fasting insulin level, or both. Even in those patients, EGIR showed a good positive relationship with measured GIR (r = 0.681, P < 0.0001). Conclusions: The proposed index without HOMA‐IR can adequately show insulin sensitivity in Japanese diabetic patients, even in cases with the limitation of HOMA‐IR application. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00076.x , 2010)     

Insulin secretory capacity and insulin sensitivity in impaired fasting glucose in Japanese

Aims/Introduction: Impaired fasting glucose (IFG) increases the risk of developing diabetes mellitus (DM). This study was carried out to characterize Japanese patients who have fasting glucose levels (FPG) between 100 and 109 mg/dL (IFG_100–109). Materials and Methods: A total of 1383 Japanese participants were examined by oral glucose tolerance test. We compared insulin secretory capacity (insulinogenic index) and insulin sensitivity (ISI composite) of IFG_100–109/normal glucose tolerance (NGT; 100 ≤ FPG < 110 mg/dL and 2‐h postchallenge glucose level (2‐hPG) < 140 mg/dL) with NGT (100 mg/dL < FPG and 2‐hPG < 140 mg/dL) and IFG_110–125/NGT (110 ≤ FPG < 126 mg/dL and 2‐hPG < 140 mg/dL). In addition, IFG_100–109 patients were analyzed in three subgroups according to glucose intolerance by 2‐hPG. Results: Of the three categories of IFG_100–109, IFG_100–109/DM had the lowest insulinogenic index despite an ISI composite showing only a small decline from IFG_100–109/NGT through IFG_100–109/IGT (100 ≤ FPG < 110 mg/dL and 140 ≤ 2‐hPG < 200 mg/dL) to IFG_100–109/DM (100 ≤ FPG < 110 mg/dL and 200 mg/dL < 2‐hPG). By multiple regression analysis, the insulinogenic index showed a significant relationship with 2‐h PG levels. Both insulinogenic index and ISI composite were decreased significantly from NGT through IFG_100–109/NGT to IFG_110–125/NGT. Conclusions: Although impaired early‐phase insulin secretion plays the more important role in the elevation of postchallenge glucose in IFG_100–109 patients, both impaired early‐phase insulin secretion and decreased insulin sensitivity are involved in the deterioration of FPG in Japanese. In addition, insulin secretory defect and decreased insulin sensitivity already have begun in patients with IFG_100–109. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00201.x, 2012)     

Study of the rate of early glucose disappearance following insulin injection: insulin sensitivity index

The euglycaemic hyperinsulinaemic glucose clamp is usually considered as the reference technique to evaluate insulin sensitivity. As it is an-expensive and time-consuming tool, we therefore tried to validate a simple insulin tolerance test (ITT) (IV bolus of 0.1 IU/kg of regular insulin, with glucose sampling at −5, 0, 3, 5, 7, 10 and 15 min) and to demonstrate its usefulness. Insulin sensitivity was measured by DG/G0 ratio (G0 = initial glycaemia, DG is the variation between G0 and the glycaemia obtained at 15 min by the calculation of the regression plot). We confirmed the existence of a correlation between the glucose uptake (mg/kg per min) evaluated by glucose clamp and the DG/G0 index (r = 0.9, P < 0.01). There was no stimulation of hormonal counter regulation during the test. The ITT was significantly correlated both with fasting insulin (r = −0.43, P < 0.01), and post-glucose load insulin concentration (r = −0.67, P < 0.01); each measurement expressing insulin sensitivity. Four groups of patients with different insulin sensitivity; controls, NIDDM, gynoid and android obese subjects, were clearly separated by ITT. We showed that fasting glycaemia and DG/G0 were correlated (y = 2.63/x − 0.093; r = 0.82, P < 0.01). These results suggest that ITT could be an easy, quick and low cost method to evaluate insulin resistance in clinical practice and epidemiological studies.     

空腹血糖水平与胰岛素抵抗的关系

目的探讨美国糖尿病协会2003年修订的空腹血糖受损(IFG)下限新切点(5·6mmol/L)划分出的中国血糖调节异常(IGR)者是否存在胰岛素抵抗。方法选取糖调节正常者(NGR)9例;以新标准划分的单纯IFG者9例;空腹及糖负荷后血糖均异常的糖调节受损者共20例,其中以新空腹血糖(FPG)切点划分的新联合糖耐量低减(IGT)者10例;以旧FPG切点划分的旧联合IGT者10例;2型糖尿病患者10例。以高胰岛素正葡萄糖钳夹技术测定受试对象的胰岛素敏感性,以静脉葡萄糖耐量试验评估其胰岛β细胞分泌功能。结果(1)新单纯IFG组、新联合IGT组和旧联合IGT组的葡萄糖输注率(GIR)[分别为(7·2±0·8、7·0±1·5、4·8±0·4)mg·kg-1·min-1]明显低于NGR组[(10·3±0·9)mg·kg-1·min-1,P值均<0·05];旧IGT组和DM组[(5·6±1·0)mg·kg-1·min-1]处于相近水平。(2)空腹胰岛素水平在所有IGR组均升高,在DM组下降。(3)新IFG组的胰岛素一、二相分泌量和NGR组相似,但随糖代谢紊乱程度加重,胰岛素一相分泌量进行性下降,而二相分泌水平先逐渐升高,后有所降低。结论(1)新空腹血糖切点划分出的中国IGR者已经出现胰岛素抵抗。(2)随糖代谢紊乱程度的加重,胰岛素分泌缺陷趋于明显。     

A simple method for quantitation of insulin sensitivity and insulin release from an intravenous glucose tolerance test.

Both insulin secretion and insulin sensitivity are important in the development of diabetes but current methods used for their measurements are complex and cannot be used for epidemiological surveys. This study describes a simplified approach for the estimation of first phase insulin release and insulin sensitivity from a standard 40-min intravenous glucose tolerance test (IVGTT), and compares these parameter estimations with the sophisticated minimal model analysis of a frequently sampled 3-h IVGTT and the euglycaemic clamp technique. For the simplified IVGTT, first phase insulin release was measured as the insulin area above basal post glucose load unit-1 incremental change (i.e. peak rise) in plasma glucose over 0-10 min, and insulin sensitivity as a rate of glucose disappearance (Kg) unit-1 insulin increase above basal from 0-40 min post-glucose load in 18 subjects who were studied twice, either basally or in a perturbed pathophysiological state (i.e. pre- and post-ultramarathon race, n = 5; pre- and post-20 h pulsatile hyperinsulinaemia, n = 8; pre- and post-thyrotoxic state, n = 5). A further 12 subjects were compared by IVGTT, and glucose clamp. In addition, seven dogs were studied three times by IVGTT during normal saline infusion and after short-term (1/2 hour) or long-term (72 hour) adrenaline infusions. First phase insulin release and insulin sensitivity estimated from the simplified IVGTT as calculated by the two methods correlated closely (rs = 0.89 and rs = 0.87, respectively), although less precisely in markedly insulin-resistant subjects and the slopes and y intercepts of the linear regression lines were similar in the basal and perturbed states.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association of insulin sensitivity and glucose tolerance with the c.825C>T variant of the G protein beta-3 subunit gene

The risk of macrovascular complications of diabetes mellitus is greatly enhanced by the presence of high blood pressure. In addition, hypertension and diabetes share insulin resistance as a common pathophysiological mechanism. Despite evidence for a common molecular genetic background of insulin resistance, glucose intolerance, and hypertension, few candidate genes have been shown to influence all of these features simultaneously. We examined the association of insulin sensitivity with the c.825C>T variant of the g-protein beta-3 subunit (GNB3), a candidate gene of hypertension, in families of Mexican-American hypertensive patients.

Methods

One hundred eighty subjects enrolled in a family study of Mexican-American hypertensive patients were recruited from hypertension clinics in Los Angeles. Subjects underwent pretreatment blood pressure recording, an oral glucose tolerance test, euglycemic hyperinsulinemic clamp, and anthropometric measurements. DNA from peripheral blood leukocytes was genotyped by polymerase chain reaction and restriction enzyme digest with BseD1 (GNB). Statistical analysis was performed by transmission disequilibrium testing.

Results

In carriers of the T-allele, blood glucose was significantly lower [(mean+S.D.) fasting: 96.7+22.9 vs. 106.7+51.7mg/dl, P=.009; oral glucose tolerance test (oGTT) 120 min: 131.7+48.7 vs. 137.8+64.9 mg/dl, P=.036], and insulin sensitivity was significantly higher (229.0+108.7 vs. 188.5+94.2 mg/kg per minute, P=.037) than in homozygous carriers of the C-allele. Blood pressure did not differ significantly between the phenotypes.

Conclusion

In a Mexican-American hypertensive population, we found evidence for higher insulin sensitivity in carriers of the T allele of the c.825C>T variant of GNB3.     

高血压并脑梗死时胰岛素敏感性指数的临床意义

目的　探讨高血压并脑梗死时胰岛素敏感性指数 (ISI)的临床意义 ,并分析胰岛素抵抗 (IR)和高胰岛素血症 (HIS)与脑内大小血管病变的关系。　方法　测定 5 7例高血压并脑梗死患者及 15例非脑血管病患者的血糖 (FPG)血清胰岛素 (FINs) ,同时采用李光伟等提出的ISI方法进行计算。　结果　高血压并脑梗死患者FINs明显高于对照组 (P <0 0 0 1) ,其ISI较对照组明显减低 (P <0 0 0 1)。脑微小血管病变组FINs明显高于大血管病变组 (P <0 0 0 1) ,其ISI较大血管病变组明显减低 ( P <0 0 0 1)。　结论　ISI是反应IR的重要指标 ,高血压并脑梗死时存在IR ,IR可能是其独立危险因素 ,脑微小血管病变可能直接与IR、HIS有关     

肥胖者与糖尿病患者胰岛素敏感性的变化

按口服葡萄糖耐量试验将研究对象分成正常年轻组、正常成年组、单纯肥胖组与糖尿病组 ,通过高胰岛素正葡萄糖钳夹试验 ,计算胰岛素敏感性指数并进行比较。结果显示肥胖组及糖尿病组患者的胰岛素敏感性下降     

Comparative evaluation of simple insulin sensitivity methods based on the oral glucose tolerance test

Aims/hypothesis We compared five surrogate insulin sensitivity (IS) methods against the euglycaemic–hyperinsulinaemic clamp. These methods were the homeostasis model assessment (HOMA) and four methods based on the OGTT (OGIS, MCRest, ISIcomp, SIORAL).Methods We compared these IS methods against the clamp (0.28 nmol·min^–1·m^–2 insulin infusion) M value in 147 women (58–61 years; BMI 19–38 kg/m²; 116 NGT, 25 IFG/IGT, six type 2 diabetic), by evaluating the correlation coefficient with M. We also tested the ability to reproduce the relationships between IS and typical IS correlates (BMI, fasting insulin, insulin to glucose OGTT area ratio and fasting, 2 h and mean glucose) by means of the discrepancy index D, in which (1) D=0 if the correlation between IS and the variable of interest is as with the clamp, (2) D is smaller than 0 if the correlation is overestimated, and (3) D is greater than 0 if underestimated.Results All IS methods correlated with M (r=0.57–0.83, p<0.0001); for MCRest the relationship was markedly curvilinear. All IS measures correlated with the considered variables (r=0.29–0.94, p<0.0005); however, no method had D0 for all variables. The best surrogates of M were OGIS (one D0) and MCRest (two D0); the other methods either under- or overestimated the degree of correlation (three or more D0), in particular with fasting insulin (HOMA: D=–57%; ISIcomp: D=–36%) and BMI (HOMA: D=–14%; ISIcomp: D=–14%; SiORAL: D=–11%).Conclusions/interpretation All IS methods were correlated with M. OGIS and MCRest were preferable to the other methods and in particular to HOMA for reproducing relationships with the independent variables.