2型糖尿病患者胰岛素抵抗与肾病变及血压的关系——附72例检测报告

目的： 探讨２ 型糖尿病者胰岛素抵抗（ＩＲ） 与肾病变及血压的关系。方法： 测定７２例２ 型糖尿病伴或不伴肾病变者的胰岛素敏感指数 （葡萄糖利用常数, ＫＩ）、尿清蛋白排泄率 （ＵＡＥＲ）, 进行２４ 小时动态血压监测（ＡＢＰＭ）。结果： 胰岛素敏感指数Ｋ１ 与ＵＡＥＲ呈负相关, 糖尿病肾病变者胰岛素抵抗、血压升高（尤其是夜间血压升高） 及血压昼夜节律异常程度均显著高于不伴肾病变者。结论： 胰岛素抵抗与肾病变及血压升高关系密切, 三者相互影响并加重病情     

二甲双胍对胰岛素抵抗患者血脂和胰岛素敏感性的影响

目的：研究二甲双胍对2型糖尿病合并高血压病患血脂和胰岛素敏感性的影响。方法：将76例2型糖尿病合并高血压病患分为31例治疗组与45例对照组，并与26例2型糖尿病组相比。三组应用格列齐特或格列吡嗪降糖，治疗组加用二甲双胍0．5g,3次／d，治疗组与对照组用卡托普利或依那普利降压。治疗2个月后胰岛素及C肽兴奋试验，测胰岛素、C肽浓度、空腹血糖、血脂，计计算胰岛素敏感指数、C肽与胰岛素面积。治疗前后测体重指数。结果：对照组的胰岛素、C肽浓度及面积与2型糖尿病组相比，上升非常显，胰岛素敏感指数降低25．17％；治疗组的C肽及胰岛素面积上升显，胰岛素敏感指数降低11．31％，总胆固醇、载脂蛋白B降低，高密度脂蛋白胆固醇、载脂蛋白A1上升，治疗组治疗后体重指数下降显。结论：二甲双胍能改善2型糖尿病合并高血压病患的血脂代谢，提高胰岛素敏感性。     

Different patterns of insulin resistance in relatives of type 1 diabetic patients with retinopathy or nephropathy: the Genesis France-Belgium Study

OBJECTIVE: Insulin resistance may be a risk factor for diabetic microangiopathy, which may have a familial component. We carried out a family-based study to determine which components of the insulin resistance syndrome are associated with diabetic retinopathy and nephropathy in type 1 diabetes. RESEARCH DESIGN AND METHODS: The Genesis France-Belgium Study is a multicenter binational study designed to investigate the genetic factors involved in the microvascular complications of type 1 diabetes using a family-based design. Probands were type 1 diabetic patients with diabetic retinopathy (classified as background, preproliferative, or proliferative) and possibly diabetic nephropathy (absent, incipient, established, or advanced). The insulin resistance score of their first-degree relatives was calculated according to their BMI and history of arterial hypertension, lipid disorders, and type 2 diabetes. RESULTS: The insulin resistance score of relatives was positively correlated with the albumin excretion rate (P = 0.0009) and fasting plasma glucose (P = 0.0003) and HbA(1c) (P < 0.0001) concentrations. This score was higher in the relatives of probands with than in those without diabetic nephropathy (P = 0.0370). Similarly, it was higher in relatives of subjects with proliferative diabetic retinopathy than in those of probands without, even after controlling for subjects with versus without diabetic nephropathy (P = 0.0379). However, the components of the insulin resistance score in relatives differed according to the severity of diabetic retinopathy or nephropathy in the probands. Obesity and history of arterial hypertension were most common in relatives of probands with proliferative diabetic retinopathy, whereas obesity and history of lipid disorders were most common in the relatives of probands with diabetic nephropathy. CONCLUSIONS: Familial insulin resistance segregates with diabetic complications: lipid disorders and obesity segregate with diabetic nephropathy, whereas arterial hypertension and obesity segregate with diabetic retinopathy.     

Effect of metabolic factors on the vasorelaxation endothelial function in patients with type II diabetes and arterial hypertension

The aim of the study was to evaluate the functional condition of the endothelium in patients with type II diabetes and arterial hypertension, depending on various metabolic factors. 85 patients aged 54.69 +/- 7.08 years were under dynamic observation. The patients had had diabetes and arterial hypertension (AH) for 5.99 +/- 4.37 and 8.65 +/- 5.52 years, respectively. The average HbAlc level was 7.91 +/- 1.73 mmol/ 1, total cholesterol level--6.35 +/- 1.81 mmol/l, body weight index--32.98 +/- 5.14 kg/m2. The average systolic and diastolic blood pressure levels were 162 +/- 7.6 and 97 +/- 3.4 mmHg, respectively. Carbohydrate and lipid exchange parameters, the extent of hyperinsulinemia and insulin resistance, and lipid peroxidation activity were evaluated. The functional condition of the endothelium was evaluated by D. Celermajer non-invasive measurement of flow-induced endothelium-dependent vasodilatation (EDVD) of the brachial artery (BA) using high-resolution ultrasound. 87% of the patients with type II diabetes and AH had endothelial dysfunction (ED), revealed by reactive hyperemia test; 30% of the patients had significant disorder of vasoreactivity (no BA artery diameter increase, but paradoxical vasoconstriction in response to reactive hyperemia). The presence and length of endothelial dysfunction (ED) in the patients with type II diabetes and AH depended on the length of diabetes, the length and extent of AH, and presence of long-term macro- and microvascular complications (coronary heart disease, diabetic retino- and nephropathy). The study did not found any dependence of the vasorelaxing endothelial function on glycosylated hemoglobin level, atherogenic blood lipid spectrum fractions, or lipid peroxidation activity. EDVD positively correlated with ApoA-1 protein level, reflecting the antiatherogenic potential of blood lipid spectrum.     

Hypertension, insulin resistance and diabetes mellitus: pathophysiological interactions and therapeutic consequences

The pathophysiological connections between insulin resistance, hypertension and type 2 diabetes are discussed in this review article. Increased blood pressure levels are often found in type 2 diabetic patients long before the diabetes itself is diagnosed. By contrast, in type 1 diabetes hypertension is predominantly the consequence of diabetic glomerulopathy. Non-pharmacological strategies should be favoured in the treatment of hypertension in type 2 diabetic patients before specific pharmacological intervention is started. Antihypertensive treatment with beta-blocking agents and diuretics is criticized by many experts in the field of metabolic disorders, since these drugs induce a deterioration of glycaemic control and lipid metabolism in diabetic patients. Since calcium channel blockers, ACE inhibitors and alpha 1-specific blocking agents have no influence on metabolism, these drugs are recommended for the antihypertensive treatment of diabetic patients. Further studies should be undertaken to clarify, whether ACE-inhibitors have a specific nephroprotective effect. Since most type 2 diabetic patients do not develop diabetic nephropathy, a possible nephroprotective effect of ACE inhibitors is only relevant to the antihypertensive treatment of type 1 diabetic patients.     

2型糖尿病患者发生糖尿病肾病的相关因素分析

目的探讨2型糖尿病患者糖尿病肾病发生的相关因素。方法采取回顾性分析方法选取2008年1月1日至2012年12月31日间门诊的868例2型糖尿病患者,按尿微量白蛋白(MAU)水平分成两组:无糖尿病肾病组和糖尿病肾病组,对两组患者的临床数据进行比较。结果①868例2型糖尿病患者中糖尿病肾病250例,占28.8%。②两组间年龄、病程、体重指数(BMI)、收缩压、舒张压、空腹血糖、餐后2小时血糖、糖化血红蛋白(HbA1c)、空腹胰岛素、胰岛素抵抗指数,胆固醇(TC)、甘油三酯(TG)、尿酸(UA)差异具有统计学意义。③Logistic回归分析结果提示:糖尿病肾病与BMI、收缩压、空腹血糖、HbA1c、TG、UA相关。结论 2型糖尿病患者应综合控制体重、血压、血糖、血脂、UA,改善代谢紊乱情况,利于糖尿病肾病的防治。     

胰岛素抵抗危险因素的探讨

目的　研究 2型糖尿病胰岛素抵抗的危险因素及其内在变化关系。方法　对 83例初诊 2型糖尿病患者 [正常体质量组 34例 ,超重和 (或 )肥胖组 4 9例 ]胰岛素抵抗的 8种危险因素 ,包括空腹血糖、空腹胰岛素、三酰甘油、胆固醇、高密度脂蛋白胆固醇、收缩压、舒张压和体质量指数 ,进行了测定 ,并与 32例正常对照组比较。结果　 2型糖尿病组空腹血糖、空腹胰岛素、三酰甘油、血压较对照组高 (P <0 .0 1～ 0 .0 5 ) ,高密度脂蛋白胆固醇较对照组低 ;2型糖尿病正常体质量组与超重和 (或 )肥胖组间血糖、血脂、血压比较差异无统计学意义 ,但超重和 (或 )肥胖组空腹胰岛素水平高于正常体质量组 (P <0 .0 1)。结论　 2型糖尿病一旦诊断 ,多存在一定程度的胰岛素抵抗 ,这种抵抗与体质量增加、三酰甘油升高有关 ,且易形成高血压 ,直接影响糖尿病多种慢性并发症及其预后     

Treating hypertension in diabetic nephropathy

OBJECTIVE: Control of hypertension in patients with diabetic nephropathy improves mortality and slows progression to end-stage renal disease. However, blood pressure is difficult to treat; multiple drug combination therapy is required and treatment algorithms to establish this are lacking. We used a stepped-care algorithm, centered on maximum doses of an ACE inhibitor or angiotensin II receptor blocker, to treat hypertension according to American Diabetes Association recommended blood pressure target goals (<130/80 mmHg) in patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS: We treated 49 consecutive patients with diabetes (13 with type 1 and 36 with type 2), diabetic nephropathy, and proteinuria > or =500 mg/24 h with a stepped-care blood pressure treatment algorithm. The level of blood pressure control achieved at most recent follow-up was assessed. RESULTS: Patients were followed for a median of 18 months (range 9-48). Mean blood pressure achieved was 140/75 +/- 23/14 mmHg in patients with type 1 diabetes and 146/76 +/- 22/14 mmHg in patients with type 2 diabetes. Target blood pressure was reached in 16 (33%) patients, 6 of 13 patients with type 1 diabetes and 10 of 36 patients with type 2 diabetes, whereas systolic blood pressure remained above the target level in the remaining patients. There was no difference in baseline blood pressure, proteinuria, or serum creatinine level between patients who were treated to target and those who were not. CONCLUSIONS: Levels of blood pressure control similar to those achieved in clinical trials in diabetic nephropathy were obtained with a stepped-care algorithm. However, in most patients, systolic blood pressure was difficult to control to target despite the use of multiple drug combination therapy.     

血管内皮生长因子与糖尿病肾病的相关性研究

目的探讨血管内皮生长因子(VEGF)与2型糖尿病肾病的关系。方法采用ELISA法测定2型糖尿病患者216例(其中单纯2型糖尿病患者112例，糖尿病肾病患者104．例)和正常对照组98例血清中的VEGF，并分析其与2型糖尿病并发肾病的关系。结果糖尿病肾病患者血清VEGF水平显著高于单纯2型糖尿病组和正常对照组。血清VEGF与收缩压、糖化血红蛋白、尿白蛋白排泄率呈显著正相关，与年龄、性别、病程、体重指数、血脂等无显著相关性。结论血清VEGF与2型糖尿病肾病密切相关，其浓度的检测对监测2型糖尿病肾病的发生、发展有重要的临床意义。     

甘油三酯/胱抑素C比值联合3项指标对糖尿病肾病的诊断价值

目的:探讨甘油三酯/胱抑素C（TG/Cys-C）比值联合糖尿病视网膜病变、糖尿病病程、收缩压3项指标对糖尿病肾病（DKD）的诊断及鉴别诊断价值。方法:回顾性分析2013年1月至2021年2月徐州市4家三甲医院肾脏病科已行肾活检的2型糖尿病合并肾损伤患者的临床资料。根据肾脏病理分型分为DKD组（51例）和非糖尿病肾病（N...     

2型糖尿病合并高血压患者胰岛素低抗

The fasting glucose(FBG),TG,CHO,HDL,LDL,ApoA1,ApoB,FIn and insulin sensitiviry index in patients with with type II diabetes mellitus complicated with hypertension were evaluated in the current study.The relationship between hypertension and abnomal level of blood lipid and insulin resistance. 1 Subjects and methods 1.1 Subjects 114 patients with type II diabetes mellitus were selected according to the WHO standards.All the patients were divided into 2 groups,normal blood pressure gr…     

Central role of sodium in hypertension in diabetic subjects

The common association between diabetes mellitus and hypertension may be promoted by several mechanisms. Patients with insulin-dependent (type I) diabetes and prone to develop nephropathy often have a familial predisposition for essential hypertension, whereas normotensive healthy offspring of nondiabetic essential hypertensive parents tend to have a reduced insulin sensitivity and increased plasma insulin levels. Na+ retention occurs as a characteristic alteration in type I or non-insulin-dependent (type II) diabetes; exchangeable body Na+ (Naex) is increased by 10% on average. This abnormality develops in the uncomplicated stage of diabetes and differentiates diabetic from nondiabetic essential hypertensive subjects. Possible Na(+)- retaining mechanisms include increased glomerular filtration of glucose leading to enhanced proximal tubular Na(+)-glucose cotransport, hyperinsulinemia (which activates several tubular Na+ transporters), an extravascular shift of fluid with Na+, and, once it occurs, renal failure. The pathogenetic role of Na+ retention in diabetes-associated hypertension is supported by positive correlations between systolic or mean blood pressure and Naex and by normalization of blood pressure after removal of excess Na+ by diuretic treatment in hypertensive diabetic subjects. The latter may also have an enhanced sensitivity of blood pressure to Na+. Plasma levels of active renin, angiotensin II, aldosterone, and catecholamines are usually normal or low in metabolically stable type I or type II diabetes. However, an exaggerated vascular reactivity to norepinephrine and angiotensin II commonly occurs already at uncomplicated stages of type I or type II diabetes. This may be a manifestation of functional (i.e., intracellular electrolytes) and/or morphological (proliferation, narrowing, and stiffening) vasculopathy. Diabetes-associated Na+ retention, vasculopathy, and a presumably inherited predisposition for both diabetes and essential hypertension may represent important complementary factors favoring the frequent occurrence of hypertension in the diabetic population.     

Association between diabetic microangiopathy and vascular endothelial function evaluated by flow-mediated vasodilatation in patients with type 2 diabetes

The main purpose of the study was to investigate the association between vascular endothelial function and diabetic microangiopathy (nephropathy, retinopathy and neuropathy) in patients with type 2 diabetes. In addition, the association between endothelial function and macroangiopathy evaluated by intimal-medial complex thickness (IMT) was also investigated. Endothelial function was evaluated non-invasively by the measurement of flow-mediated vasodilatation (FMD) of the brachial artery. Diabetic nephropathy and neuropathy were assessed by urinary albumin excretion (UAE) and motor or sensory nerve conduction velocity (MCV, SCV), respectively, and retinopathy was evaluated by an ophthalmologist using the Davis classification. FMD was measured in 102 patients with type 2 diabetes and in 20 control subjects, and showed a tendency to be lower in the diabetic patients. There was a significant decrease in FMD in patients with proliferative diabetic retinopathy, compared with those in patients with no diabetic retinopathy. FMD showed significant positive correlations with MCV and SCV, and significant negative correlations with log UAE, systolic blood pressure and diabetic duration, but no correlation was obtained between FMD and IMT. In stepwise regression analysis, MCV alone showed a significant association with FMD. In conclusion, our results show that in patients with type 2 diabetes FMD is closely associated with all types of microangiopathy, with neuropathy being most strongly associated with FMD; however, FMD is not associated with macroangiopathy evaluated by IMT.     

Kinetics of sodium-lithium countertransport activity in patients with uncomplicated type 1 diabetes.

1. Increased erythrocyte sodium-lithium countertransport activity has been reported to be associated with nephropathy in type 1 diabetes and linked to a family history of essential hypertension. 2. This study aimed to determine the mechanism of increased sodium-lithium countertransport activity. Sodium-lithium countertransport kinetics were measured in uncomplicated and hyperlipidaemic type 1 diabetic patients. 3. In the nine out of 31 uncomplicated type 1 diabetic patients who had high sodium-lithium countertransport activity, the sodium affinity (Km) was normal but the maximum velocity (Vmax) was increased. 4. Hyperlipidaemia, when present in diabetic patients, was associated with increased sodium-lithium countertransport activity, but could not explain the high activity in uncomplicated type 1 diabetic patients in whom plasma lipid concentrations were normal. 5. Sodium-lithium countertransport activity is increased in type 1 diabetes by a mechanism different to that in essential hypertension, where the mechanism is a low Km (increased sodium affinity). Hence familial hypertension cannot explain the raised sodium-lithium countertransport activity in type 1 diabetes.     

Prevention of coronary heart disease in type 2 diabetes

Patients with diabetes without a prior myocardial infarction are at a similar risk of coronary heart disease (CHD) events as non-diabetic subjects with a prior myocardial infarction. Furthermore, prognosis after the first myocardial infarction is worse in diabetic compared to non-diabetic patients. Therefore, management of cardiovascular risk factors in subjects with diabetes should be as vigorous as in patients with known CHD who have had a myocardial infarction. Randomised controlled trials have shown that efficacy of cholesterol lowering and antihypertensive therapy in type 2 diabetes is at least as effective as in non-diabetic subjects in preventing macrovascular disease. Antiplatelet therapy with aspirin reduces the risk of CHD events in high-risk patients and the benefit is similar in subjects with and without diabetes. Improved glycaemic control has a modest beneficial effect on CHD risk. There is residual excess risk of CHD in type 2 diabetes, which is not explained by traditional cardiovascular risk factors. Insulin resistance may partly mediate this. Prediabetic subjects who are insulin resistant have more adverse levels of triglycerides, high density lipoprotein (HDL)-cholesterol and blood pressure than those who are insulin sensitive. Moreover, factors associated with insulin resistance are significant predictors of CHD events in subjects with diabetes, in addition to conventional risk factors. The thiazolidinedione, pioglitazone, improves glycaemia and insulin sensitivity in hyperglycaemic patients. It also improves insulin and triglyceride levels and lowers blood pressure. Thiazolidinediones have been found to have vasculo-protective effects in both acute and chronic vascular injury in animal models. For prevention of CHD in type 2 diabetes a multi-factorial approach should be considered, including improved glycaemic control, aggressive management of dyslipidaemia and hypertension, anti-platelet therapy, reduction of insulin resistance and use of agents that improve insulin sensitivity.     

甘精胰岛素、阿卡波糖与盐酸贝那普利联合治疗2型糖尿病早期肾病的临床观察

目的：观察甘精胰岛素、阿卡波糖与盐酸贝那普利联合治疗2型糖尿病早期肾病的临床疗效。方法：将62例2型糖尿病合并糖尿病肾病Ⅲ期患者用甘精胰岛素作为基础量使空腹血糖达标,三餐时联合阿卡波糖口服控制餐后血糖,辅以盐酸贝那普利治疗,观察治疗前后血糖、血压及尿白蛋白／肌酐的变化。结果：经甘精胰岛素、阿卡波糖治疗后空腹和餐后2h血糖明显下降,联合盐酸贝那普利治疗可改善胰岛素抵抗,并使UAER明显下降。结论：甘精胰岛素作为基础量、联合阿卡波糖控制血糖,辅以盐酸贝那普利口服是治疗2型糖尿病合并早期糖尿病肾病的方法之一,疗效肯定,无低血糖发生。     

Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients

BACKGROUND: Smoking and cardiovascular autonomic dysfunction are associated with high mortality in type 2 diabetic patients. This study tested the hypothesis that smoking is associated with insulin resistance/hyperinsulinaemia and cardiovascular autonomic dysfunction in type 2 diabetic patients who are not treated with insulin. MATERIALS AND METHODS: The study patients were 22 current smokers with type 2 diabetes mellitus (age: 57 +/- 5 years, mean +/- SD) and 30 age-matched never-smoked patients with type 2 diabetes mellitus (control group, 57 +/- 8 years). The quality of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin (F-IRI), homeostasis model assessment (HOMA) index and haemoglobin A1c (HbA1c). The severity of smoking status was expressed by the Brinkman index, which is calculated as number of cigarettes per day multiplied by years of smoking. Cardiovascular autonomic function was assessed by baroreflex sensitivity (BRS), heart-rate variability, plasma norepinephrine concentration and cardiac (123)I-metaiodobenzylguanidine (MIBG) scintigraphic findings. RESULTS: Baroreflex sensitivity was lower in the current smokers group than in the never-smoked group (P < 0.05). Early and delayed (123)I-MIBG myocardial uptake values were lower (P < 0.05, and P < 0.01, respectively) and the percentage washout-rate of (123)I-MIBG was higher (P < 0.0001) in the current smokers group than in the never-smoked group. Fasting immunoreactive insulin (F-IRI) concentration (P < 0.0001) and the homeostasis model assessment (HOMA) index (P < 0.0001) were higher in the current smokers group than the never-smoked group. Multiple logistic regression analysis revealed that smoking was independently predicted by F-IRI and the percentage washout-rate of (123)I-MIBG. CONCLUSIONS: The results of the study suggested that smoking was associated with cardiovascular autonomic dysfunction and hyperinsulinaemia and that F-IRI and the percentage washout-rate of (123)I-MIBG were independent predictors of smoking in these Japanese patients with type 2 diabetes mellitus.     

不同性别糖尿病肾病患者危险因素研究

目的探讨男性和女性糖尿病肾病患者危险因素之间的差异。方法收集2004年1月-2008年12月以糖尿病肾病为诊断的住院患者1300例,根据入院日期以系统的方法随机纳入650例患者,排除20例尿常规正常和血肌酐值正常的患者,共630例,其中男342例,女288例,平均年龄65岁。288例女性患者中有271例为绝经后妇女,平均年龄48岁。比较女性和男性糖尿病肾病患者危险因素的差别。结果①绝经后糖尿病肾病患者占女性患者的94．1％;②女性糖尿病肾病患者组收缩压、脉压及糖化血红蛋白水平高于男性糖尿病。肾病患者组,两者有统计学意义（P〈0．05）;③两组患者在发病年龄,病程,糖尿病家族史,空腹血糖水平,低密度脂蛋白,高密度脂蛋白,血肌酐,24h尿蛋白定量、是否使用血管紧张素转换酶抑制剂,血管紧张素受体拮抗剂,胰岛素,是否透析,死亡率均无统计学意义（P〉0．05）。结论在女性糖尿病肾病患者中绝经后妇女所占比例较高,女性糖尿病肾病患者收缩压、脉压及糖化血红蛋白水平均高于男性糖尿病肾病患者,雌激素的水平可能导致差异的产生。     

实验性2型糖尿病肾病大鼠模型研究

目的建立2型糖尿病肾病大鼠模型。方法雄性Wistar大鼠高糖高脂喂养8周后,腹腔注射链脲佐菌素（STZ,30mg／kg）诱导糖尿病大鼠。通过葡萄糖耐量试验和胰岛素抵抗指数判断胰岛素抵抗情况。结果在注射STZ之前,高糖高脂喂养大鼠和对照组血糖基本相似,而血清胰岛素水平明显高于对照组。在注射STZ之后,高糖高脂大鼠血糖明显增高,血清胰岛素降至对照组水平。在第10周末,2型糖尿病大鼠体重、血压、胆固醇、甘油三酯、24小时尿蛋白定量和肾重指数较对照组存在差异而肾功无明显差异。。肾脏病理显示2型糖尿病大鼠具有典型2型糖尿病肾病的病理改变。结论联合高糖高脂饮食和小剂量STZ方法建立的动物模型可以用于2型糖尿病肾病的研究。     

Familial clustering of arterial blood pressure, HDL cholesterol, and pro-insulin but not of insulin resistance and microalbuminuria in siblings of patients with type 2 diabetes

OBJECTIVE: To test the hypothesis that selected abnormalities cluster in type 2 diabetic families. Offspring of patients with type 2 diabetes have a 40-60% chance of developing type 2 diabetes and an increased frequency of impaired glucose tolerance (IGT) or unknown diabetes. These offspring also show metabolic abnormalities of type 2 diabetes, such as insulin resistance, high insulin and pro-insulin, low HDL cholesterol levels, arterial hypertension, and microalbuminuria. RESEARCH DESIGN AND METHODS: We studied 87 families including at least one type 2 diabetic patient, i.e., 87 probands and 146 siblings; 60 spouses of probands with no family history of diabetes were compared with siblings. Familial clustering was evaluated by 2 methods: concordance of siblings and probands for a given abnormality (method 1) and intraclass correlation coefficients of values within each family (method 2). RESULTS: At oral glucose tolerance testing, 24 siblings had type 2 diabetes, 31 siblings had IGT, and 14 spouses had IGT (P = 0.0012 vs. siblings). With method 1, familial clustering occurred for microalbuminuria, insulin resistance, arterial hypertension, HDL cholesterol and pro-insulin levels; with method 2, familial clustering was observed for the same variables except for microalbuminuria. With both method 1 and 2, familial clustering for insulin resistance disappeared, whereas familial clustering for arterial blood pressure, HDL cholesterol, and pro-insulin remained after correction for BMI; after further restriction of analysis to probands and to siblings with normal glucose tolerance, familial clustering for pro-insulin was observed only with method 2. CONCLUSIONS: These data indicate that siblings of diabetic patients are at high risk for selected features of type 2 diabetes.