Beta cell function in insulin-treated non-insulin-dependent diabetic patients

Non--insulin-dependent diabetes mellitus (NIDDM) patients, 94 in number, who were treated with insulin for various reasons for periods ranging from 2 to 10 years, were investigated to study the effect of long-term insulin therapy and also the effect of anti-insulin antibodies on the beta cell function. Insulin antibody titer and the stimulated C-peptide (CP) did not correlate with the duration of insulin therapy, dose of insulin, or the severity of hyperglycemia. The antibody titers were low in 45%, moderate in 10%, and high in 45%; no correlation was found between the antibody titers and the CP values. Satisfactory control of hyperglycemia was obtained in 54 patients after change of treatment to oral hypoglycaemic agents (OHA). The other 40 patients required continued insulin therapy. The initial CP values were similar in both the groups before initiating the new therapeutic patterns. Those who responded to OHA showed improved CP values on follow-up. The beta cell response to exogenous insulin is heterogeneous in NIDDM patients. In many patients, adequate preservation of beta cell function is present even after long-term insulin therapy. Many of them respond to OHA. Insulin antibodies do not influence the secretory status of the beta cells in NIDDM patients.     

Clinical characteristics and outcomes of diabetic ketoacidosis in Pakistani adults with Type 2 diabetes mellitus.

AIMS: The aim of this study was to describe the clinical characteristics and outcomes of diabetic ketoacidosis (DKA) in Pakistani adult population with Type 2 diabetes mellitus. METHODS: We reviewed the medical records of all adult patients admitted with a diagnosis of DKA and Type 2 diabetes mellitus (DM) and followed their clinical course and outcome. Follow-up data were obtained by chart review or telephone contact where necessary. RESULTS: Fifty-seven patients fulfilled criteria for inclusion in the study. Their mean age was 48 +/- 7 years. The mean body mass index was 25.5 +/- 6.2 kg/m2. Forty-nine had a prior history of Type 2 DM but DKA was the initial presentation in 14%. Nine were on no treatment, 40 were using oral hypoglycaemic agents and eight were on insulin. A history of prior DKA was noted in eight patients. Infections were the most common precipitating factor (63%). There were 12 deaths. Follow-up after a period ranging between 12 and 43 months revealed that 30/45 patients remained on OHA without recurrence of DKA. CONCLUSION: This report highlights the need for the growing recognition of DKA occurring in adults with Type 2 DM in the South Asian population. Mortality rates are unacceptably high but the majority of survivors remain insulin independent.     

Breast arterial calcifications associated with diabetes and hypertension

AIM: To investigate the relationship between breast arterial calcifications (BACs) and systemic hypertension (HT) and diabetes mellitus (DM). METHODS: Mammograms and patient records of 2406 women who were screened for breast cancer or had undergone diagnostic mammography were reviewed retrospectively. Mammograms were evaluated for the presence of arterial calcification and results were coded. Patients who had been using insulin or oral hypoglycemic agents were included in the diabetic group; patients who had been using antihypertensive agents were included in the hypertensive group. Diabetes was defined as use of oral hypoglycemic agents or insulin and hypertension was defined as use of antihypertensive agents. RESULTS: The prevalence of BACs among diabetics (25.4) was higher than among hypertensives (17.6%). The prevalence in the nondiabetic, nonhypertensive (NDNH) group was lowest (7.3%). The prevalence increased with age. BAC was seen almost four times more in diabetic patients and three times more in hypertensive patients than in NDNH controls. CONCLUSION: BACs are associated with diabetes and hypertension. BAC on a mammogram may indicate unsuspected diabetes or hypertension, especially after 59 years of age.     

LIMITATION OF JOINT MOBILITY AND SHOULDER CAPSULITIS IN INSULIN- AND NON-INSULIN-DEPENDENT DIABETES MELLITUS

Limited joint mobility and shoulder capsulitis were evaluatedin 109 consecutive diabetic patients attending an out-patientdiabetic clinic. Forty-nine had insulin-dependent diabetes mellitus(IDDM) and 60 had non-insulin-dependent diabetes mellitus (NIDDM).Seventy-five normal subjects were also examined. Limitationof joint mobility was detected in 24 (49%) patients with IDDMand in 31 (52%) patients with NIDDM but in only 17 (20%) normalsubjects (p < 0.001). There were no significant differencesbetween diabetic patients with and without joint limitationwith regard to age, sex, type of DM, mean daily insulin dosageand overall diabetic control as assessed by estimation of glycosylatedhaemoglobin concentration. However, patients with impaired jointmobility had a longer duration of diabetes (p = 0.01) and asignificantly increased frequency of retinopathy compared topatients without joint limitation (p < 0.05). Normal subjectswith restricted joint mobility were older than those withoutrestriction (p = 0.05). Shoulder capsulitis was present in 19%of patients with diabetes mellitus and 5% of normal subjects.However, there was no significant association between limitedjoint mobility and shoulder capsulitis in the diabetics. KEY WORDS: Diabetes mellitus, Shoulder, Joint hypomobility     

糖尿病患者接受双时相门冬胰岛素30治疗时的临床基线情况——IMPROVE^TM研究中国亚组结果

目的选取IMPROVE^TM的中国亚组数据,了解中国糖尿病患者治疗时的基线特征。方法经临床医生判断预启用BIAsp30治疗的糖尿病患者为人选对象。由医生记录基线时的人口统计学数据、病史、起始BIAsp30治疗的原因、血糖控制情况和具体治疗方案。结果共人选糖尿病患者21729例（女性37％,男性63％）,平均糖尿病病程（4．86±4．98）年,2型糖尿病（T2DM）患者占99．7％,平均年龄（54．0±12．7）岁,平均体重指数BMI（24．63±3．12）kg／m^2。24％的受试者患有大血管并发症;40．5％患有微血管并发症。基线时,32．3％的患者从未进行过降糖治疗,59．3％仅接受过口服降糖药（OHA）治疗,8．1％单独应用胰岛素或联合OHA治疗。受试者基线时平均糖化血红蛋白（HbA1c）为（9．46±2．04）％。转用BIAsp30治疗的最主要原因是期望改善血糖控制,89．1％的患者采用了每日2次的给药方式。结论中国糖尿病患者血糖控制差且并发症发生率高,糖尿病治疗尤其是胰岛素治疗的开展是滞后的。     

182个2型糖尿病家系865人调查分析

目的 建立一个可用于系统研究2型糖尿病的高发家系人群,对2型糖尿病家系的发病情况、临床及生化指标进行分析.方法 按美国糖尿病学会标准,已诊断有糖尿病家族史的糖尿病先证者进行三代家族史和血统成员的调查研究,全部非患者采血做口服葡萄糖耐量试验确认,并对新老患者用免疫学方法,系谱分析和分子生物学方法排除1型糖尿病、青少年发病的成年型糖尿病(MODY)和线粒体遗传阳性家系,最终筛选出具有2个或2个以卜2型糖尿病患者的家系182个(实际调查共865人)并进行分析.全部家系成员均检查血糖、血脂、胰岛素C肽释放试验.结果 受调查的865名成员中2型糖尿病、单纯空腹血糖受损、单纯葡萄糖耐量减退、空腹血糖受损合并葡萄糖耐量减退总患病率为59.88%,2型糖尿病患病率为45.43%.新榆出2型糖尿病患者94例,单纯空腹血糖受损者14例,单纯葡萄糖耐量减退者61例,空腹血糖受损合并葡萄糖耐量减退者27例.先证者父、母、同胞、子女的患病率明显高于普通人群.糖尿病组收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇、甘油二酯、体重指数、胰岛素抵抗指数明显高于空腹血糖受损和(或)葡萄糖耐量减退组或未发病者.在2型糖尿病发病前的葡萄糖耐量减退阶段,收缩压、舒张压、总胆固醇、低密度脂蛋白胆固醇、甘油三酯、体重指数、胰岛素抵抗指数也高于正常人群.结论 2型糖尿病发病具有明显的家族聚集性,高血压、高血脂、肥胖是2型糖尿病的高危因素,胰岛素抵抗在糖尿病发病前已存在.     

Antibodies to GAD in Japanese patients classified as Type 2 diabetes at diagnosis. High titre of GAD Ab is a predictive marker for early insulin treatment--report of west Japan (Kyushu, Yamaguchi, Osaka) study for GAD Ab(+) diabetes.

AIM: We evaluated the prevalence of GAD Ab in Japanese Type 2 diabetic patients treated with oral hypoglycaemic agents (OHA) and/or diet and followed GAD Ab(+) patients to assess the usefulness of GAD Ab as a marker for future insulin treatment prospectively. METHODS: A total of 2658 Japanese Type 2 diabetic patients treated by OHA and/or diet were randomly selected between April 1996 and December 1998. The clinical characteristics at entry were assessed and patients were followed for 1-3 years. RESULTS: The overall prevalence of GAD Ab among Type 2 diabetic patients was 2.0%. Forty-five had a history of diabetes of < or = 5 years (short history) while those with duration > 5 years (long history) totalled nine. Among them, 47% of patients with a short history did not require insulin in the follow-up period. However, none of those with a long history required insulin treatment within 2 years. Comparison of patients based on GAD titre in those with short history showed that 33% of patients in the high-titre group (> or = 20 U) required no insulin treatment in the first year of follow-up. In contrast, this proportion was 80% in the first and 67% in the second year in the low-titre group (< 20 U). CONCLUSIONS: The prevalence of GAD Ab in Japanese patients with a short and long history of diabetes was 2.8% and 0.9%, respectively. The presence of GAD Ab in Japanese Type 2 diabetic patients with a short history of diabetes is a marker for early insulin treatment.     

Further evidence for an association between non-insulin-dependent diabetes mellitus and chronic hepatitis C virus infection.

Non-insulin-dependent diabetes mellitus (NIDDM) may be associated with chronic hepatitis C virus (HCV) infection. This was studied further in two parts. First, 1,151 patients with HCV-related cirrhosis and 181 patients with hepatitis B virus (HBV)-related cirrhosis, well matched for age, sex, and severity of cirrhosis, were reviewed retrospectively. The prevalence of diabetes mellitus was higher in HCV-related cirrhosis (23.6%) than in HBV-related cirrhosis (9.4%; odds ratio [OR], 2.78; 95% confidence interval [CI], 1.6-4.79; P =.0002). The prevalence of diabetes mellitus was associated closely with the Child-Pugh score (OR, 3.83; 95% CI, 2. 38-6.17; P <.0001) and increasing age (OR, 1.02; 95% CI, 1.00-1.03; P =.0117). Second, 235 patients with biopsy confirmed chronic HBV or HCV underwent an oral glucose tolerance test. Only 1 of 70 patients with chronic viral hepatitis without cirrhosis was diabetic. However, 31 of 127 patients with HCV-related cirrhosis (24.4%) were diabetic compared with 3 of 38 patients with HBV-related cirrhosis (7.9%, P =.0477). The major variables associated with NIDDM were cirrhosis (OR, 14.39; 95% CI, 1.91-108; P =.0096) and male sex (OR, 4.64; 95% CI, 1. 32-16.18; P =.0161). Fasting insulin levels in 30 patients with HCV-related cirrhosis and diabetes mellitus were elevated significantly, which was consistent with insulin resistance. However, acute insulin responsiveness was reduced in all patients with HCV infection and diabetes suggesting concomitant B-cell dysfunction. This study confirms an association between HCV and NIDDM.     

Diabetes mellitus in Benghazi

The records of 10,772 diabetic patients registered in Benghazi diabetic clinic during the period 1969-1985 were analysed. Non-insulin dependent diabetes mellitus (NIDDM or type II) accounted for 97.8% of patients. Of the whole clinic population 77.2% were below 40 years of age. The disease started below the age of 20 years in 1.9%. Male to female sex ratio was 1:1.2. Family history of diabetes was positive in 23.77%. Sixty-nine per cent of patients were obese. Patients presented with symptoms suggestive of diabetes mellitus in 79.7% of cases.     

Hypoglycemia associated hospitalizations in a population with a high prevalence of non-insulin-dependent diabetes mellitus.

In order to evaluate the rates, causes, and clinical features of hospitalizations associated with hypoglycemia in a population with a high prevalence of non-insulin-dependent diabetes mellitus (NIDDM), a retrospective analysis of medical records was conducted in a multi-hospital primary care system on the Navajo Indian Reservation. During an estimated 26,125 person-years of observation among diabetic patients, there were 126 hypoglycemia-associated admissions related to diabetes among 109 diabetic patients, yielding a hospitalization rate of 4.7 per 1000 person-years (95% CI 4.1-5.7). Using estimates of drug utilization based on a defined daily dose, hospitalization rates were 5.8 per 1000 PY (95% CI 4.4-7.6) for chlorpropamide, 16.0 per 1000 PY (95% CI 9.5-26.9) for glyburide, and 9.1 per 1000 PY (95% CI 6.9-11.9) for insulin. After stratification by age, the relative risk for hypoglycemia-associated hospitalization among patients prescribed glyburide compared to those prescribed chlorpropamide was 2.8 (95% CI 1.6-4.9). Hypoglycemia-associated hospitalizations were relatively common among patients with NIDDM, particularly among those treated with glyburide.     

Insulin requirement in elderly patients with non-insulin dependent diabetes mellitus (NIDDM)

Diabetes mellitus in the elderly is mainly of the non-insulin dependent type (NIDDM). A large proportion of such patients are treated with insulin, after many years of therapy with oral hypoglycemic agents (OHA), on the assumption that these lose their efficacy with time. Moreover, many such patients are obese and show preserved insulin release. In the present study 45 obese subjects with NIDDM (14 under good metabolic control and 31 who presented hyperglycemia for at least 3 mo prior to testing) were placed on a strictly hypocaloric diet (800 Kcal/d) for 20 to 24 d. All of these patients had preserved insulin release. At the end of the trial, all the patients presented a significant reduction in body weight and a near normalization of the blood glucose profile, as well as a significant decrease both in the serum cholesterol and triglyceride levels and in the systolic blood pressure. On the basis of these results, insulin and OHA could be reduced in all the patients and suspended in some of these. The decrease in blood glucose levels was the same in all the patients regardless of the length of time that each had suffered from NIDDM. Five non-obese patients were placed on the same regimen, but the daily insulin dose could not be reduced. These data indicate that the majority of obese elderly patients with NIDDM are unnecessarily treated with insulin or with OHA, while diet alone would be sufficient to keep them under good metabolic control.     

Maternally transmitted susceptibility to non-insulin-dependent diabetes mellitus and left ventricular hypertrophy

OBJECTIVES: We studied the association of diabetes transmission with left ventricular hypertrophy (LVH) in patients with non-insulin-dependent diabetes mellitus (NIDDM). BACKGROUND: It is suggested that NIDDM has a strong genetic basis and that maternally transmitted NIDDM is associated with mitochondrial deoxyribonucleic acid (DNA) mutations. However, genetic factors for LVH in NIDDM are unknown. METHODS: We investigated the family history of diabetes and the prevalence of LVH using electrocardiography in 834 patients with NIDDM, of whom 199 also underwent echocardiography. RESULTS: Of the 834 patients, 121 had diabetic mothers, 122 had diabetic fathers and 30 had both. The LVH criterion of S(v1) + R(V5) or R(v6) >35 mm was met in 148 patients. The percentage of patients having diabetic mothers was higher in those with LVH criterion (29%) than without it (16%) (p < 0.001), but the percentage of patients having diabetic fathers was similar in those with LVH (18%) and without it (18%). Compared with the 683 patients with nondiabetic mothers, the 151 patients with diabetic mothers were younger and had earlier onset of diabetes. The percentage of patients having diabetic siblings was also higher in those with diabetic mothers (31%) than in those with nondiabetic mothers (18%) (p < 0.001). On electrocardiograms, the prevalence of LVH was higher in patients with diabetic mothers (28%) than in those with nondiabetic mothers (15%) (p < 0.001). Echocardiograms showed that patients with diabetic mothers had greater left ventricular wall thickness and mass than those with nondiabetic mothers. In multivariate analysis, the family history of diabetes in mothers was an independent factor to LVH, but the family history of diabetes in fathers was not. CONCLUSIONS: Maternal transmission of diabetes was associated with LVH in patients with NIDDM. Some genetic factors of diabetes, such as mitochondrial DNA abnormalities, may contribute to the development of LVH in maternally transmitted NIDDM.     

胰岛素与口服降糖药对新诊断2型糖尿病患者β细胞功能的影响

目的比较胰岛素（Ins）与口服降糖药（OHA）治疗对新诊断2型糖尿病（T2DM）患者胰岛β细胞功能的影响。方法64例新诊断T2DM患者随机分为Ins组和OHA治疗组。定期检测PG、Ins、C-P水平及其他相关指标,用HOMA-β、HOMA-IR及△I30／△G30来评价胰岛功能变化。结果（1）随访至6个月时,两组上述指标均元统计学差异（P均〉0．05）。（2）随访至12个月时,与OHA组比,Ins组HOMA-β及△I30／△G30较治疗前显著上升（P〈0．05）。两组HOMA-IR无统计学差异（P〉0．05）。结论与0HA相比,早期Ins治疗能更好地保护B细胞功能。     

102例酮症倾向2型糖尿病患者的临床特征分析

目的探讨酮症倾向2型糖尿病的临床特征及治疗方法。方法102例酮症倾向2型糖尿病在胰岛素降糖治疗1个月后,停用胰岛素给予口服降糖药单用或联合治疗,接受至少1年的随访。根据最终的治疗方案,分为口服降糖药（OHA）组和胰岛素治疗（INS）组。结果（1）经过1年的随访,77．5％的患者通过口服药物可将血糖得到较满意的控制,22．5％的患者因严重高血糖或酮症需要再次接受胰岛素治疗。（2）酮症倾向的2型糖尿病具有普通2型糖尿病许多类似的临床特点和病理生理特征。（3）与INS组相比,OHA组起病时的血糖、HbA1c、胰岛素强化治疗达标时间、男性构成比较低,而BMI、甘油三酯、糖尿病家族史构成比较高（P〈0．05）。（4）在高血糖得到控制后,OHA组胰岛素分泌指数（MBCI）和MBCI的变化值均大于INS组（P〈0．05）。（5）多元回归分析发现,高血糖控制后的MBCI、：BMI为选择不同治疗方案（口服药治疗或胰岛素治疗）的主要参考因素。结论酮症倾向2型糖尿病可能是2型糖尿病的一个亚型。在短期胰岛素治疗后,大多数可以改用口服降糖药,高血糖控制后的MBCI、：BMI将有助于不同降糖方案的选择。     

Impact of treatment of coronary artery disease with sirolimus-eluting stents on outcomes of diabetic and nondiabetic patients

Patients with diabetes mellitus are at increased risk for repeat interventions and mortality after coronary angioplasty and stenting. The efficacy of sirolimus-eluting stents (SESs) to improve the outcomes of these patients is a focus of interest. In the first 1,407 patients treated with SESs at our institution, 492 were diabetic (insulin dependent diabetes mellitus [IDDM], n = 160 and non-insulin-dependent DM [NIDDM], n = 332). The in-hospital and 1- and 6-month clinical outcomes were compared with those of 915 patients without DM (non-DM). The baseline characteristics were similar, except for more women, obesity, previous myocardial infarction, coronary artery bypass grafting, and renal insufficiency in the DM group (p <0.001). Compared with non-DM patients, DM patients had higher in-hospital (p <0.05) and 1-month mortality (p = 0.02). IDDM patients had more in-hospital renal failure (p = 0.04) and Q-wave myocardial infarctions (1.6% vs 0%, p = 0.04) compared with NIDDM patients, and higher mortality (3.1% vs 0.8%, p = 0.04) and subacute stent thromboses (2.3% vs 0.5%, p = 0.07) than non-DM patients at 30 days. At 6 months, DM patients had a higher incidence of Q-wave myocardial infarction, target lesion revascularization-major adverse cardiac events, and composite of death and Q-wave myocardial infarction than non-DM patients (6.0% vs 2.7%, p = 0.01). Late outcomes between the IDDM and NIDDM groups were similar. Multivariate analysis showed diabetes and acute renal failure as independent predictors of target lesion revascularization-major adverse cardiac events. In conclusion, our data showed that, despite a reduction in repeat revascularization, coronary intervention with SESs in diabetic patients is limited by higher mortality at 1 month and a higher incidence of Q-wave myocardial infarction and target lesion revascularization-major adverse cardiac events at 6 months compared with non-DM patients. Careful surveillance is required in IDDM patients undergoing SES implantation.     

Effect of BMI,insulin dose and number of injections on glycaemic control in insulin-using diabetic patients

Background: Strict glucose control is essential to the prevention of diabetic complications. The level of glycaemic control in insulin-treated patients with diabetes mellitus (DM) in a routine clinical setting is not known.Methods: In a cross-sectional survey comprising 8 hospitals in the Rijnmond area, The Netherlands, age, body mass index (BMI), insulin dose, number of injections, and HbA1_c were scored in 712 patients with insulin-dependent DM (IDDM) and 462 patients with non-insulin-dependent DM (NIDDM).Results: In IDDM and NIDDM patients, respectively, age (mean ± SD) was 40 ± 17 and 65 ± 12 years, BMI was 24.1 ± 3.5 and 27.3 ± 4.1 kg/m², daily insulin dose was 49 ± 18 and 44 ± 18 U (P < 0.001). Intensive therapy (≥ 4 injections or continuous subcutaneous insulin infusion) was used in 59% of IDDM and 13% of NIDDM patients. HbA1_c below the upper normal limit was achieved in 11% of the patients, and within 20% above the upper normal limit in 37%. Obesity was positively associated with HbA1_c in NIDDM patients (P < 0.01). A higher insulin dose was associated with higher HbA1_c in both IDDM and NIDDM patients (P < 0.01).Conclusions: Good glycaemic control was established in 37% of our patients. Intensive insulin treatment and higher insulin dose did not improve glucose regulation. Obesity is a risk factor for poor glycaemic control.     

Antibodies to Glutamic Acid Decarboxylase in Japanese Diabetic Patients with Secondary Failure of Oral Hypoglycaemic Therapy

Some patients with non-insulin-dependent (Type 2) diabetes mellitus (NIDDM) are positive for antibodies to glutamic acid decarboxylase (anti-GAD), which have been shown to be a useful marker for the diagnosis and prediction of insulin-dependent (Type 1) diabetes mellitus (IDDM). Anti-GAD positive NIDDM patients tend to develop insulin deficiency. We investigated the prevalence of anti-GAD in 200 NIDDM with secondary failure of oral hypoglycaemic therapy (SF) and 200 NIDDM well controlled by diet and/or sulphonylurea agents (NSF). Twenty-two of 200 (11 %, p < 0.05) SF patients and 6 of 200 (3 %) NSF patients were anti-GAD positive. The positive rate for anti-GAD was as high as 23.8 % in the non-obese and insulin deficient SF patients. The SF patients with anti-GAD tended to be non-obese and to have an impaired release of endogenous insulin. The interval before development of secondary failure was not associated with the presence of anti-GAD in this study. In conclusion we found that anti-GAD was positive in as many as 11 % of the SF patients, suggesting that autoimmune mechanisms may play an important role in the pathogenesis of secondary failure of sulphonylurea therapy. © 1997 by John Wiley & Sons, Ltd.     

Secondary failure to oral hypoglycaemic agents in non-obese patients with non-insulin-dependent diabetes is related to reduced insulin release

The frequency of secondary failure to oral hypoglycaemic agents (OHA) in patients with non-insulin dependent diabetes (NIDDM) is still unknown, despite more than 30 years of use of OHA. The term secondary failure should be limited to patients who, despite maximal dosages of OHA and despite full compliance with diet and therapy, are no longer controlled and require insulin to obtain an acceptable glucose metabolism. We evaluated 248 out-patients, either on OHA, or on insulin because of poor metabolic control with OHA, in order to assess duration of treatment with OHA since diagnosis, by means of actuarial curves (Mantel-Cox test). Patients with low relative body weight (RBW less than or equal to 100) experienced secondary failure earlier and more often than obese patients (RBW greater than 120) or overweight (RBW 101-120) patients. In 66 of the above out-patients, 33 OHA-treated and 33 insulin-treated, matched for age at onset and duration of disease, islet-cell-antibodies (ICA) and C-peptide release at fasting, 6 min after i.v. glucagon and post prandially were evaluated. Only among lean and overweight patients, was C-peptide release significantly lower in insulin-treated than in OHA-treated patients; differences disappeared in obese patients. ICA were found in only 7 patients (10.6%). HLA phenotype was different from that of healthy blood donors for the loci HLA B5, B13, CW4, with no differences between OHA-treated and insulin-treated patients. These data indicate that secondary failure is more frequent in lean patients with NIDDM, and is related to reduced insulin release.     

重组促胰岛素分泌素对2型糖尿病患者血浆FGF-21水平的影响

目的 探讨注射用重组促胰岛素分泌素(recombinant exendin-4 for injection,E-4)治疗对2型糖尿病(T2DM)患者血浆成纤维细胞生长因子-21(FGF-21)水平的影响.方法 采用酶联免疫法测定40例健康对照和33例T2DM患者血浆FGF-21水平以及使用E-4治疗前后的变化,探讨血浆FGF-21水平与体重指数(BMI)、腰臀比(WHR)、血脂、血糖及胰岛素等的关系.结果 T2DM患者血浆FGF-21水平明显升高[(2.16±0.20)vs(1.53±0.36)μg/L,P<0.05].多元逐步回归分析表明,HbAlc及TG是影响血浆FGF-21水平的独立危险因素(YFGF-21=1.370+0.069XHbAlc+0.056XTG).E-4治疗后T2DM患者血浆FGF-21水平明显低于用药前[(2.15±0.21)vs(1.99±0.12)μg/L,P<0.05].结论 T2DM患者血浆FGF-21水平改变可能与其代谢紊乱和胰岛素抵抗有关,并可能是E-4作用的生物靶点之一.