Diabetes mellitus and impaired fasting glucose in Alaska Eskimos: the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study

Aims/hypothesis We aimed to: (1) define the prevalence of type 2 diabetes and IFG in Eskimos in Norton Sound, Alaska; (2) determine correlates of prevalent diabetes in this population; and (3) compare the prevalence of diabetes in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study with other samples of Eskimos, Inuit, American Indians and US blacks, whites and Mexican Americans. Methods The GOCADAN Study enrolled 1,214 participants ≥18 years who were members of extended pedigrees from the Norton Sound region of Alaska. Diagnosed type 2 diabetes was based on reported use of insulin or hypoglycaemic medications and a medication inventory. Fasting glucose measurements were obtained to ascertain IFG status and undiagnosed diabetes according to American Diabetes Association (ADA) criteria. OGTTs were performed to ascertain diabetes according to the World Health Organization (WHO) definition. We used logistic regression analysis to model factors that were significantly associated with odds of prevalent ADA diabetes. Results The prevalences of ADA diabetes and IFG were 3.8% (5.0% of women; 2.2% of men) and 15.6% (13.9% of women; 17.7% of men), respectively. In the subset of 787 participants who took the OGTT, the prevalences of ADA and WHO diabetes were 5.1 and 6.9%, respectively. The adjusted odds of ADA diabetes was 2.8 times higher in participants meeting Adult Treatment Panel III criteria for abdominal obesity than in those who did not. The statistically significant sex-related difference in diabetes prevalence did not persist in multivariable analyses. Conclusions/interpretation Alaska Eskimos have a low prevalence of type 2 diabetes. The high prevalence of IFG indicates that diabetes may become increasingly problematic in this population. Abdominal obesity in women may help explain why diabetes prevalence differs according to sex.     

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。     

Association between insulin resistance and metabolic syndrome risk factors in Japanese

Aims/Introduction: It is important to identify individuals at risk of metabolic syndrome (MetS), namely those with insulin resistance. Therefore, the aim of the present study was to find anthropometric and metabolic parameters that can better predict insulin resistance. Subjects and Methods: We selected 3899 individuals (2058 men and 1841 women), excluding those with fasting plasma glucose (FPG) ≥126 mg/dL, on medication for hypertension, dyslipidemia or diabetes, and those with a history of advanced macrovascular disease. Using multivariate analyses, we selected components for obesity, lipids, and blood pressure based on the strength of their association with the homeostasis model assessment of insulin resistance (HOMA‐IR). Results: In multiple linear regression analysis, body mass index (BMI), waist circumference (WC), triglycerides (TG), high‐density lipoprotein–cholesterol (HDL‐C), and systolic blood pressure (SBP) were selected in men and women, and the effect of BMI on HOMA‐IR outweighed that of WC. In multiple logistic regression analysis, BMI, TG, and SBP were significantly associated with HOMA‐IR ≥2.5 in both genders, but WC and HDL‐C were only selected in men. Combinations of BMI, TG, SBP, and FPG showed higher HOMA‐IR values than those of the existing MetS components, considered useful for the identification of individual with higher insulin resistance. Conclusions: Body mass index, TG and SBP were selected as components significantly related to insulin resistance. The selected components were fundamentally adherent to the existing MetS criteria, the only difference being the measure of obesity, in which a stronger association with insulin resistance was observed for BMI than WC. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00162.x, 2011)     

脂蛋白脂肪酶与胰岛素抵抗

脂蛋白脂肪酶(LPL)是脂蛋白代谢中甘油三酯分解的主要限速酶.LPL与胰岛素抵抗之间存在一定关系,可以通过多种途径导致胰岛素抵抗.据报道指出LPL可以作为胰岛素抵抗的一个生物指标.因此研究LPL对于改善胰岛素抵抗具有十分重要的意义.本文对LPL与胰岛素抵抗之间的关系作一简述.     

血清补体3与代谢综合征及胰岛素抵抗关系研究

目的探讨血清补体3（C3）与代谢综合征（MS）及其组分,以及胰岛素抵抗（IR）的关系。方法96例MS患者和141例非MS患者用免疫比浊法检测血清C3,同时检测BMI、血糖、血压、血脂。结果MS患者血清C3水平明显高于非MS患者,且C3水平随MS组分的增加而升高（P〈0．01）。相关分析显示血清C3浓度与BMI、SBP、FPG、TC、TG、HOMA—IR呈正相关。结论血清C3水平与MS组分相关,与IR有关。     

脂蛋白脂酶与代谢综合征

脂蛋白脂酶是脂质代谢的关键酶,主要水解甘油三酯,在乳糜微粒及极低密度脂蛋白的代谢中发挥重要作用.该酶的缺乏或活力异常,将导致糖、脂代谢紊乱.代谢综合征(MS)是以腹型肥胖,高血压,糖、脂代谢异常等多重心血管危险因素聚集为特征的临床综合征.越来越多的动物及临床证据表明,脂蛋白脂酶参与了 MS的发生、发展,故脂蛋白脂酶的研...     

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。     

Ezetimibe combined with standard diet and exercise therapy improves insulin resistance and atherosclerotic markers in patients with metabolic syndrome

Aims/Introduction

Ezetimibe lowers serum lipid levels by inhibiting intestinal absorption of dietary and biliary cholesterol. However, the effect of ezetimibe on insulin resistance remains unclear. The aim of the present study was to examine this issue in patients with metabolic syndrome in local-dwelling Japanese, who were not being treated with lipid-lowering drugs.

Materials and Methods

In 2009, 1,943 participants received a health examination in the Tanushimaru Study, a Japanese cohort of the Seven Countries Study, of whom 490 participants had metabolic syndrome. Among them, 61 participants (41 men and 20 women) were examined in the present study. They were treated with 10 mg of ezetimibe once a day for 24 weeks, combined with standard diet and exercise therapy.

Results

Bodyweight (P < 0.001), body mass index (P < 0.001), systolic blood pressure (P = 0.003), diastolic blood pressure (P < 0.001), triglycerides (P = 0.002), non-high-density lipoprotein cholesterol (P = 0.001), low-density lipoprotein cholesterol (P < 0.001) and homeostasis model assessment of insulin resistance (P = 0.011) significantly decreased after the observational period. There were no statistically significant differences in the effects of ezetimibe between men and women. Univariate analysis showed that the reduction of homeostasis model assessment of insulin resistance was not associated with the improvement of other metabolic components.

Conclusions

Ezetimibe combined with standard diet and exercise therapy improves not only bodyweight and atherogenic lipid profiles, but also insulin resistance, blood pressure and anthropometric factors in metabolic syndrome in local-dwelling Japanese. Interestingly, the improvement of insulin resistance had no correlation with other metabolic components.     

代谢综合征患者胰岛素抵抗与醛固酮水平的相关性研究

目的探讨代谢综合征（MS）胰岛素抵抗（IR）及高胰岛素血症与血浆醛固酮水平的关系。方法101例原发性高血压（EH）、135例特发性醛固酮增多症（IHA）患者按是否伴MS各分为两个亚组进行比较。结果EH伴MS组血浆卧位醛固硐（ALD）水平、胰岛素曲线下面积（InsAUC）、HOMA-IR及IR所占百分率均显著高于非MS组;IHA伴MS组血浆卧位ALD水平、InsAUC、HOMA-IR及IR所占百分率均显著高于非MS组和EH组。相关分析显示,伴MS两亚组的卧位ALD水平均与InsAUC及HOMA-IR显著正相关。结论MS患者较高的血浆ALD水平与高胰岛素血症及IR显著正相关,在高血压和心血管并发症的发生中起到一定作用。     

Akt2 Gene common allelic variants in insulin resistance and the metabolic syndrome

Background and aimSeveral lines of evidence indicate that glucose homeostasis may be under the control of Akt2 and it can therefore be seen as a candidate gene for human insulin resistance (IR) and related phenotypes. The aim of our study was the identification of Akt2 common allelic variants that might modulate susceptibility to IR and related metabolic abnormalities.Methods and resultsThe Akt2 gene (exons, 5′ and 3′ regulatory regions) was re-sequenced in samples of 50 blood donors from the Gargano region. Two single nucleotide polymorphisms (SNPs) in 5′ (rs11669332 and rs969531) and two in 3′ (rs2304186 and C1658T) regulatory regions were exploited in an association study using 661 healthy unrelated Caucasian individuals from the same region.Individuals being homozygous for the T allele of rs11669332 (an Akt2 promoter) showed lower systolic blood pressure (p = 0.04), total/HDL cholesterol ratio (p = 0.02) and the metabolic syndrome score (p = 0.04), while carriers of the A allele of rs969531 (in 5′-UTR) showed higher systolic blood pressure (p = 0.027). The association between phenotypic traits and possible haplotypes was tested as well. However, no haplotype affecting the risk of metabolic abnormalities was found.ConclusionsTwo variants in 5′ regulatory region of Akt2 gene are associated and may modulate susceptibility to IR and related metabolic abnormalities.     

老年代谢综合征患者血清游离脂肪酸与胰岛素抵抗的相关性研究

目的探讨老年代谢综合征（MS）患者中血清游离脂肪酸（FFA）水平与胰岛素抵抗（IR）的相关性。方法选取2009年1月至2010年6月上海交通大学附属第一人民医院老年科住院患者96例,年龄≥65岁。采用2005年国际糖尿病联盟提出的标准,分为MS组38例及非MS组58例,分别检测血清FFA、胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆同醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FBG）、空腹胰岛素（FINS）,用稳态模式（HOMAModel）公式计算HOMA—IR评估胰岛素抵抗。分别测各组体重、腰围、身高,计算体质指数（BMI）。结果1、MS组的身高、体重、腰围、BMI、FBG、FINS及HOMA—IR、TC、HDL—C、TG水平均高于非MS组（P〈0．01）,MS组的FFA水平高于非MS组（P〈0．01）;2、直线相关分析显示在MS组中FFA水平与FBG、FINS、HOMA-IR呈正相关（P〈0．05）;3、多元逐步回归分析结果显示FFA与HOMA—IR独立相关（P〈0．05）。结论老年MS患者FFA升高,FFA水平与m存在相关性,FFA是老年MS患者IR的独立危险因素。     

罗格列酮联合阿司匹林治疗对糖尿病代谢综合征患者胰岛素抵抗的影响

目的探讨罗格列酮（RGZ）联合阿司匹林（Asp）治疗对糖尿病代谢综合征（MS）患者胰岛素抵抗（IR）的影响。方法126例MS患者按随机区组设计法分为基础治疗组（31例）,Asp组（31例）,RGZ组（32例）,RGZ联合Asp组（32例）,观察各组治疗前后FPG、2hPG、HbA1c、Ins、C-P、C—RP、纤维蛋白原水平及HOMA—IR等的变化。结果RGZ联合Asp组FPG、2hPG、Ins、HOMA—IR、炎症因子水平均较其他三组下降。结论RGZ联合Asp应用可协同改善糖尿病MS患者IR,并具有抗炎作用。     

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.     

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.

剖析代谢综合征组分间的内在联系

代谢综合征(MS)表现为一组心血管疾病危险因素的聚集,因其严重威胁人类健康而越来越受到关注.其发病机制末完全明确,围绕Ms还存在诸多争议.目前其定义并不统一,但涉及的组分相同.既往MS曾被称作胰岛素抵抗综合征,随着研究的深入,发现这种称谓并不恰当.胰岛素抵抗(IR)在MS的发生、发展中起了最为重要的作用,而并非MS的唯一病理生理机制.腹型肥胖与IR、血脂紊乱、高血压、高血糖、炎性反应状态密切相关.     

老年代谢综合征患者血清瘦素水平与胰岛素抵抗的研究

目的：探讨老年代谢综合征患者血清瘦素水平与血糖、血脂、胰岛素和胰岛素抵抗的关系。方法：根据相应的诊断标准,分别收集老年2型糖尿病患者49例,血脂异常患者39例,代谢综合征104例,以同期门诊体检人员49例作为对照组,测定体重指数（BMI）、腰臀比（WHR）、空腹血糖、空腹血清胰岛素（FINS）、空腹血清三酰甘油、瘦素水平等,以稳态模型公式计算胰岛素抵抗指数（HOMA—IR）．并分析瘦素与各参数问的相关性。结果：与正常对照组相比,代谢综合征患者HOMA—IR、血清瘦素水平和FINS均显著增高（t分别为11．849、2．839、3．280,均P〈0．01）。与糖尿病组和血脂异常组相比．代谢综合征组患者的血清瘦素水平（t=3．058,t=2．911,P〈0．01）、FINS（t=2．750,P〈0．01;t=2．482,P〈0．05）和HOMA—IR值（t=3．072,t=7．749,P〈0．01）亦显著增高。直线回归相关分析显示瘦素水平与BMI呈正相关（r=0．418,P〈0．01）,校正BMI和性别后与WHR无相关性（r=0．042,P〉0．05）,但与FINS、HOMA—IR呈正相关（r：0．257,P〈0．01;r=0．124,P〈0．05）。结论：老年代谢综合征患者中普遍存在高胰岛素血症及胰岛素抵抗：瘦素水平与BMI、FINS及HOMA—IR的相关性提示瘦素是胰岛素抵抗、代谢综合征发生的重要相关因素之一。     

HDL2-cholesterol/HDL3-cholesterol ratio was associated with insulin resistance,high-molecular-weight adiponectin,and components for metabolic syndrome in Japanese

AimsRecent data have suggested a relationship between the high-density lipoprotein (HDL) subclass ratio and metabolic syndrome (MetS). However, limited information is available regarding the relationships between the HDL subclass ratio and insulin resistance, associated adipocytokine levels, and MetS components. The associations of the high-density lipoprotein 2 cholesterol (HDL₂-C) to high-density lipoprotein 3 cholesterol (HDL₃-C) ratio with the homeostasis model assessment of insulin resistance (HOMA-IR) index, high-molecular-weight adiponectin (HMW-Ad) levels, and MetS components were examined.MethodsThe study included 1155 Japanese subjects who met our inclusion criteria and underwent an annual health examination that included an HDL subclass analysis.ResultsThe HDL₂-C/HDL₃-C ratio and the HMW-Ad level gradually decreased as the number of MetS components increased. In contrast, HOMA-IR gradually increased as the number of MetS components increased. The HDL₂-C/HDL₃-C ratio correlated inversely with HOMA-IR and positively with the HMW-Ad level. A strong positive correlation was observed between the HDL₂-C/HDL₃-C ratio and the HDL-C level. The HDL₂-C/HDL₃-C ratio exhibited moderate negative correlations with the body mass index, waist circumference, and triglyceride level. Weak negative correlations were observed for the HDL₂-C/HDL₃-C ratio with the systolic and diastolic blood pressure and fasting plasma glucose levels.ConclusionsOur data indicated that the HDL₂-C/HDL₃-C ratio was associated with insulin resistance, the HMW-Ad level, and MetS components, and it was useful for evaluating MetS in Japanese individuals.     

代谢综合征患者血清抵抗素、瘦素、C反应蛋白与体重和胰岛素抵抗的相关性

目的探讨代谢综合征（MS）患者血清抵抗素、瘦素和C反应蛋白（C-RP）水平与血脂、中心性肥胖和胰岛素抵抗（IR）的关系。方法50例MS男性患者和20例年龄相匹配的正常男性对照者（NC）,按腰围将MS患者分为肥胖组和非肥胖组,测定受试者空腹血清抵抗素、瘦素、C-RP、身高、体重、腰围、臀围、血压、血糖、血脂及胰岛素,计算HOMA-IR。结果MS患者肥胖组、非肥胖组和NC组相比血清抵抗素、瘦素、C-RP水平明显升高。结论MS患者血清抵抗素、瘦素及C-RP水平均明显升高,且与肥胖及IR程度明显相关,因而抵抗素、C-RP、瘦素可能在MS的发生发展中有重要作用。     

随访肥胖人群中代谢综合征发生的相关因素分析

目的 探讨影响随访肥胖人群代谢综合征(MS)发生的相关因素.方法 研究对象来自2000年筛查出的413例单纯肥胖者(体重指数≥25 kg/m2)及196名正常体重的健康人,7年后对此人群的体脂、血压、血脂、血糖情况进行随访调查.并测定随访前后胰岛素抵抗指数和血管内皮功能.结果 共随访到553例,其中单纯肥胖者381例(单纯肥胖组),正常体重者172名(正常体重组).单纯肥胖组MS累积发生率35.17％,正常体重组MS累积发生率8.14％.单纯肥胖组有MS者与无MS者比较,基线时的腰围、腰臀比、甘油三酯、空腹血糖、空腹胰岛素、稳态模型评估的胰岛素抵抗指数( HOMA-IR)显著升高(均P＜0.05),内皮依赖性舒张功能(EDD)明显降低(P＜0.01).正常体重组发生MS者的腰围、腰臀比、空腹胰岛素也高于未发生MS者(均P＜0.05),而EDD低于未发生者(P＜0.05).Logistic回归分析显示,男性性别、腰围、腰臀比、空腹血糖、HOMA-IR和EDD是发生MS的危险因素.结论 腹型肥胖、胰岛素抵抗和内皮功能障碍是MS发生的基本病因.