正常糖耐量人群中血压与胰岛素抵抗及胰岛素分泌关系研究

目的研究血压与胰岛素敏感性和胰岛B细胞功能之间的关系。方法采用多阶段分层整群随机抽样方法对江苏省内人群进行研究,根据口服葡萄糖耐量试验结果选取18岁以上正常糖耐量人群952例,根据血压不同,分为正常血压组、正常高值组、1级高血压组、2级高血压组、3级高血压组。胰岛素敏感性采用ISIM及1/HOMA-IR评价;胰岛B细胞功能采用HOMA-β、InsAUC30/GluAUC30和InsAUC120/GluAUC120评估。结果同正常血压组相比,正常高值组和1、2、3级高血压组的1/HOMA-IR分别下降11.1%、14.8%、24.1%、33.3%(P<0.001),ISIM分别下降10.3%、15.5%、27.6%、37.1%(P<0.001);InsAUC30/GluAUC30指数分别升高11.1%、41.3%、42.9%、101.2%(P<0.001),InsAUC120/GluAUC120分别升高13.2%、46.5%、54.2%、96.9%(P<0.001);5组间的HOMA-β有上升趋势,但差异无统计学意义。处置指数DI(包括基础时相DI0、早时相DI30、总时相DI120)在5组别间均没有明显变化。结论正常糖耐量人群中,随着血压升高,胰岛素敏感性逐渐下降,出现胰岛素抵抗,胰岛素分泌逐渐上升,尚未出现胰岛分泌功能的缺陷。     

The relationship between uric acid and metabolic syndrome in normal glucose tolerance and normal fasting glucose subjects

Elevated serum uric acid (SUA) concentrations have been suggested to associate with metabolic syndrome (MetS) and its components. However, limited information is available regarding the relationship between SUA and MetS in subjects with normal glucose levels. A total of 501 subjects with normal fasting glucose and normal glucose tolerance were included in the study. Anthropometrical and biochemical parameters were examined using standard methods. The updated NECP criteria were used to define the MetS. Values of SUA above the sex-specific percentile 75 were used to define hyperuricemia. The prevalence of general and abdominal obesity, hypertension, hypertriglyceridemia, low-HDL, smokers, MetS and insulin resistance was significantly greater in the fourth SUA quartile. Multiple regression indicated that SUA was independently predicted by BMI, triglyceride and 2 h glucose in women, and BMI, triglyceride, 2 h glucose and cholesterol in men. Logistic regression analysis showed that the obesity, hypertriglyceridemia, MetS and insulin resistance were independent determinants of hyperuricemia in women. In men, hyperuricemia was associated with the obesity, hypertriglyceridemia and hypercholesterolemia. Factor analysis yielded three factors interpreted as weight/waist, blood pressure and lipid/glucose. Including SUA in the model did not affect total variance of factor analysis. Our results indicate that SUA is associated with MetS and its components even in subjects with normal glucose levels. General obesity was the major determinant of hyperuricemia in this population. The data from this study do not show the contribution of SUA as an additional component of the MetS.     

Association of fasting serum insulin and fasting serum glucose levels with cognitive impairment in Chinese nonagenarians/centenarians

In this study, we examined the association of fasting serum insulin (FSI) and fasting serum glucose (FSG) with cognitive impairment in the very elderly using a sample of Chinese nonagenarians/centenarians. This study used data from a survey that was conducted in 2005 on all residents aged 90 years or more in a district with 2,311,709 inhabitants. FSG, FSI, and cognitive function were analyzed. The sample included 661 unrelated Chinese individuals (aged 90–108 years; mean, 93.52 ± 3.37 years; 67.17 % women; FSI, 6.27 ± 2.27 mU/mL; FSG levels, 4.46 ± 1.45 mmol/L). The prevalence of cognitive impairment was 61.81 % and that of hypoinsulinemia was 31.92 %. Individuals with hypoinsulinemia showed lower cognitive function scores (14.81 ± 5.79 vs. 15.78 ± 5.24, t = 2.160, P = 0.031). No differences in cognitive function score between different FSI and FSG groups were significant, and no differences in FSI and FSG between individuals with and without cognitive impairment were statistically significant. Unadjusted multiple logistic regressions showed that hypoinsulinemia, impaired fasting glucose, or diabetes did not change the risk of cognitive impairment significantly. In summary, we found that in elderly subjects, cognitive function appeared associated with FSI, and higher FSI may be associated with enhanced cognitive function.     

Association between insulin and blood pressure in a community population with normal glucose tolerance.

The purpose of this study was to examine the relationship between insulin and BP in patients with normal glucose tolerance. The associations between systolic and diastolic BP, age, body mass index, waist/hip ratio, fasting glucose, insulin, fructosamine, glycosylated haemoglobin, lipid profile, and glucose and insulin two hours after 75 g oral glucose were examined in 1,520 employees of a public utility company and non-medical staff of a district hospital. Patients with impaired glucose tolerance or diabetes mellitus (using WHO criteria) were excluded. In men (mean age 35.6 +/- 8.7 years, n = 769), both systolic and diastolic BP were positively associated with age, body mass index, waist/hip ratio, fasting and 2h glucose and insulin, triglycerides and apolipoprotein B, and were negatively associated with glucose/insulin ration, and high density lipoprotein and cholesterol and its subfractions. However, in multivariate analysis only body mass index, age, fasting glucose and insulin were independent predictors of systolic BP, while only body mass index and age predicted diastolic BP. In women, age, glycosylated haemoglobin, 2h glucose/insulin ratio, 2h glucose, fructosamine and triglycerides were predictors of systolic BP. Fasting or 2h insulin, and glucose/insulin ratios did not predict diastolic BP. The results are compatible with the hypothesis that systolic hypertension may reflect a hyper-insulinaemic state even in those with normal glucose tolerance, independent of age and obesity. The association between plasma lipids and blood pressure is probably mediated by insulin and obesity.     

正常糖耐量、糖耐量低减和糖尿病人群中胰岛素抵抗与胰岛素分泌功能研究

流行病学调查表明胰岛素抵抗 (ＩＲ)不仅存在于糖尿病(ＤＭ)患者中 ,在糖耐量低减 (ＩＧＴ)甚至正常糖耐量 (ＮＧＴ)人群中也发现ＩＲ存在。本研究从糖尿病流行病学的角度探讨ＩＲ和胰岛素分泌 (ＩＳ)在ＮＧＴ、ＩＧＴ和ＤＭ 3组人群中的改变。一、对象和方法1.对象 :874例馒头餐后 2ｈ指尖毛细血管血糖超过6 .6 7ｍｍｏｌ/Ｌ者行 75ｇ口服葡萄糖耐量 (ＯＧＴＴ)试验 ,并测定空腹胰岛素 (ＦＩＮＳ)和ＯＧＴＴ 2ｈ胰岛素 (ＰＩＮＳ)。根据 1985年ＷＨＯ糖尿病诊断标准 ,将所有受试者分为 3组 :ＮＧＴ 35 1例 ,年龄 (44 .0± 14 .7)岁 ;ＩＧＴ…     

Factors affecting fasting serum C-peptide levels in Micronesians: comparison with a Caucasoid population

Summary Fasting serum C-peptide immunoreactivity was determined on Nauruans, a Micronesian population with a high prevalence of diabetes. In Micronesian subjects neither age nor gender had a significant effect on fasting serum C-peptide. In non-diabetic subjects, as has been shown previously for Caucasiod subjects, both obesity and fasting plasma glucose levels were determinants of fasting serum C-peptide. Obesity was the major determinant. Taken overall, mean fasting serum C-peptide increased then possibly fell in subjects grouped by increasing 2-h post-glucose plasma glucose levels. Mean fasting serum C-peptide in newly-diagnosed diabetic subjects was greater than that in non-diabetic subjects with a similar degree of obesity, supporting the concept that the transition to diabetes may be associated with an increase in insulin resistance. The data for non-diabetic subjects were compared with serum C-peptide measured in the same laboratory on samples from a Caucasoid population in Busselton, Western Australia. There was no difference in fasting serum C-peptide level between Micronesian and Caucasoid subjects approximately matched for obesity and fasting plasma glucose levels.     

Ethnic difference in inter-East Asian subjects with normal glucose tolerance and impaired glucose regulation: A systematic review and meta-analysis focusing on fasting serum insulin

AimsTo investigate ethnic difference by focusing on fasting serum insulin (FSI) in inter-East Asian subjects with normal glucose tolerance (NGT) and impaired glucose regulation (IGR).MethodsData sources included MEDLINE and EMBASE between 2001 and 2007. We conducted a search for articles containing mean or geometric mean values of FSI in East Asian subjects with NGT, IGR, or type 2 diabetes (T2DM). The Monte Carlo method was used for simulation of the mean and standard deviation of individual measures in each ethnic group; calculation of the median ratio and 95% confidence interval of individual measures between ethnic groups.ResultsTwenty-two articles fully met our pre-determined criteria and were included in the meta-analysis. Results of the meta-analysis revealed that FSI level is significantly lower in Japanese subjects with NGT, IGR, or T2DM than in Korean and Chinese subjects.ConclusionsEthnic difference in FSI level between East Asians was observed in not only T2DM patients but also subjects with NGT or IGR. The lower FSI level in Japanese subjects was accompanied by lower triglyceride level. These results suggest that ethnic difference in dietary habit was one of the most influential factors for the ethnic difference in FSI.     

血糖正常的高血压患者做葡萄糖耐量试验的临床意义

目的：探讨对空腹血糖正常的高血压患者进行葡萄糖耐量试验（OGTT）的意义。方法：选择既往无糖代谢异常病史，空腹血糖〈5．6mmol／L，确诊原发性高血压的成人患者；行OGTT2h血糖测定，如果OGTT2h血糖≥11．1mmol／L，再次行OGTT以排除糖尿病。同时观察年龄，入院时血压、体重指数、血肌酐、血尿酸、甘油三酯、高密度脂蛋白等参数的改变。结果：本组266例患者中检出糖耐量减低者（OGTT2h血糖≥7．8mmol／L）共98例（36．8％），其中确诊2型糖尿病29例（OGTT2h血糖≥11．1mmol／L），占10．9％。结论：所有空腹血糖正常的高血压患者均应进行OGTT，以发现可能的糖代谢异常，使患者能得到早期干预，更显著地降低心血管事件发生的风险。     

Effects of impaired fasting glucose and impaired glucose tolerance on predicting incident type 2 diabetes in a Chinese population with high post-prandial glucose

AIMS: To ascertain which impaired glucose homeostasis at baseline is predictive of conversion to type 2 diabetes in both men and women in a high-risk non-diabetic population. METHODS: The screening survey for type 2 diabetes was conducted in 1994, and a follow-up study of 627 high-risk non-diabetic individuals at baseline was carried out in 1999 in Beijing area. A total of 70 men and 76 women developed diabetes during the 5-year follow-up. RESULTS: After adjustment for age, body mass index, smoking, systolic blood pressure, family history of diabetes, total cholesterol, triglycerides, antihypertensive medication, occupation, education, urine albumin excretion rate, and fasting insulin, the odds ratios for incidence of diabetes were 1.00, 2.04 (95% CI 0.84-4.97), 7.82 (2.66-23.00), 9.38 (3.30-26.69) in men with normal glucose, isolated IFG, isolated IGT, and both IFG and IGT, respectively. In women, the corresponding odds ratios were 1.00, 2.19 (0.91-5.30), 1.62 (0.72-3.67), and 8.79 (2.98-25.93), respectively. CONCLUSIONS: This study shows that combined IFG and IGT at baseline is a strong risk predictor for the development of diabetes in both men and women. Isolated IGT is also a predictor of diabetes in Chinese men.     

糖耐量正常人股部脂肪分布及含量与胰岛素敏感性的关系

目的建立应用MRI测量股部脂肪分布和含量的方法,初步探讨中国人群中股部脂肪分布和含量与胰岛素抵抗的关系。方法选取30例上海地区糖耐量正常者,其中正常体重组和超重/肥胖组各15例。利用高胰岛素正葡萄糖钳夹试验评价其胰岛素敏感性并用MRI测定股部脂肪分布和含量。结果与正常体重组比较,超重/肥胖组股部皮下脂肪[(176．7±21．6)cm~2 vs(115．0±12．8)cm~2,P＜0．05],筋膜下脂肪[(75．4±4．4)cm~2 vs(57．5±4．7)cm~2,P＜0．01],肌间隙脂肪[(28．3±3．2)cm~2 vs (14．5±1．1)cm~2,P＜0．01]明显增多,且胰岛素敏感性(稳态期葡萄糖利用率)显著降低[(4．54±0．43) cm~2vs(7．88±0．75)cm~2,P＜0．01]。在股部脂肪分布中,股部筋膜下脂肪与胰岛素敏感性的相关性最强。多元逐步回归分析进一步证实股部筋膜下脂肪增加是引起胰岛素抵抗的独立因素。结论股部脂肪分布与含量与胰岛素敏感性相关,其中股部筋膜下脂肪对胰岛素敏感性影响最显著。     

不同糖耐量个体血清瘦素水平与特异胰岛素、胰岛素原及胰岛素敏感性的关系探讨

目的　研究不同糖耐量人群空腹瘦素水平与特异胰岛素、胰岛素原及胰岛素敏感性之间的关系。方法　用放射免疫法测量 5 4例正常糖耐量 (NGT)、33例糖耐量低减 (IGT)、4 7例新发 2型糖尿病 (DM )的空腹瘦素水平、口服葡萄糖耐量试验 (OGTT) 0、1/2、1、2h的特异胰岛素 (SI)和胰岛素原 (PI)。结果　 (1)多元逐步回归分析显示 ,性别、体重指数 (BMI)、胰岛素敏感性指数是影响空腹瘦素水平最重要的因素 (校正的R2 分别为 0 .2 5 1、0 .4 19、0 .4 38,P值分别为 <0 .0 0 1、<0 .0 0 1、<0 .0 5 ) ;空腹血清瘦素水平与OGTT各时间点PI、SI、PI/SI值无相关性。 (2 )在校正性别、BMI等影响因素后 ,空腹血清瘦素水平在不同糖耐量组差异无显著性 ;DM组OGTT各时间点PI/SI值明显高于IGT组和NGT组 (P <0 .0 1) ;胰岛素敏感性 (ISI)为NGT组 >IGT组 >DM组 (P <0 .0 0 1)。结论　在测定特异胰岛素、胰岛素原时 ,血清瘦素水平除了与性别、BMI相关外 ,尚与胰岛素敏感性 (按SI水平计算 )相关 ;不同糖耐量状态对血清瘦素水平无明显影响 ;DM组存在胰岛素不敏感、PI/SI失调     

Effects of miglitol taken just before or after breakfast on plasma glucose,serum insulin,glucagon and incretin levels after lunch in men with normal glucose tolerance,impaired fasting glucose or impaired glucose tolerance

Aims/Introduction: One of the reasons for the poor adherence to α‐glucosidase inhibitor (αGI) treatment is the need to take medication three times a day. We hypothesized that the administration of miglitol might be effective for the next meal if the miglitol‐induced inhibition of α‐glucosidase activity persists until the next meal. In the present study, we evaluated whether the administration of miglitol just before or after breakfast was effective for postprandial glucose excursion after lunch without taking miglitol at lunch. Materials and Methods: We measured the plasma glucose, serum insulin and glucagon, plasma active glucagon‐like peptide‐1 (GLP‐1), and total glucose‐dependent insulinotropic polypeptide levels in non‐diabetic men. Miglitol was given to each patient according to four different intake schedules (control: no drug; intake 1: drug given just before breakfast [50 mg]; intake 2: drug given 30 min after the start of breakfast [50 mg]; intake 3: drug given at the same time as intake 2, but without eating breakfast [50 mg]). Results: Both intake 1 and intake 2 had a smaller area under the curve (AUC) for plasma glucose excursion after lunch, compared with the control. Intake 2 had a larger AUC for active GLP‐1 after lunch, compared with intake 1. Conclusions: Intake 1 and intake 2 can improve postprandial hyperglycemia after lunch. The results of the present study raise the possibility that the administration of miglitol twice a day might be effective and might help to improve treatment adherence among diabetic patients. This trial was registered with UMIN Clinical Trial Registry (no. UMIN000002896). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00129.x, 2011)     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.     

Effects of weight loss in obese subjects with normal fasting plasma glucose or impaired glucose tolerance on insulin release and insulin resistance according to a minimal model analysis

We investigated effects of weight loss from diet and exercise regimen in obese subjects with normal fasting plasma glucose or impaired glucose tolerance (IGT) on insulin release capacity and insulin sensitivity. Eight subjects were recruited among visceral obesity patients (4 men, 4 women; age range, 24 to 57 years; body mass index [BMI], 32.8 to 60.3 kg/m(2)). All were admitted to Chiba University Hospital for 2 weeks, were treated with a tapering 5,023 to 2,930 kJ diet, and were given exercise equivalent to 628 kJ/d. For assessments, we used a combination of C-peptide secretion rate determination and minimal model analysis as previously reported. BMI and visceral fat area (V) significantly decreased (BMI on initiation v after intervention, 43.0 +/- 3.2 v 40.3 +/- 3.1 kg/m(2), P <.05; V, 224 +/- 22 v 188 +/- 22 cm(2); P <.05). Fasting immunoreactive insulin (F-IRI) and leptin concentrations decreased significantly. Capacity for insulin release in response to glucose increased in all subjects (first-phase insulin secretion [CS1], 4.66 +/- 4.05 v 6.81 +/- 4.57 ng/mL/5 min, P <.05), but the insulin sensitivity index (S(i)) did not change significantly. These data suggest that weight reduction early in development of type 2 diabetes can oppose progression of diabetes by improving capacity for insulin release.     

血糖正常人群不同空腹及口服葡萄糖耐量试验2h血糖水平与代谢综合征的关系

目的在血糖正常的中国人群样本中比较不同血糖表型人群代谢综合征患病率及其各组分水平。方法来自2002年青岛湛山社区糖尿病流行病学调查。共有2438名20-74岁常住居民参加调查,其中2109人进行了人体测量学指标测定、口服75g葡萄糖耐量试验（OGTT）并检测总胆固醇、甘油三酯、高密度脂蛋白胆固醇（HDL-C）、空腹血胰岛素等。本研究选取其中1341名血糖正常者作为研究对象,根据OGTr2h血糖是否大于空腹血糖水平分为表型A组（2h血糖≤空腹血糖）和表型B组（2h血糖〉空腹血糖）。组间比较采用t检验、协方差分析或卡方检验。多因素logistic回归分析评价血糖表型与代谢综合征的相关性。结果研究对象中表型A、B的比例分别为42．3％（564／1341）和57．9％（777／1341）。校正年龄、性别的影响后,表型B组平均体质指数、腰围、收缩压、舒张压、空腹血胰岛素、甘油三酯、非HDL-C均高于表型A组,而且表型B组代谢综合征患病率[19．1％（149／777）]亦高于表型A组[14．7％（83／564）],差异有统计学意义（X^2=3．91,P〈0．05）。多因素logistic回归分析发现,具有血糖表型B是代谢综合征的危险因素,相应的OR值为1．32（95％CI1．02-1．74）。结论在血糖正常的人群中,OGTT2h血糖不能回落到空腹血糖水平的人群合并代谢综合征的风险较高,提示可能对心血管疾病的早期筛查和预防提供依据。