β-Cell function in type 2 diabetes

Different in vivo tests explore different aspects of β-cell function. Because intercorrelation of insulin secretion indices is modest, no single in vivo test allows β-cell function to be assessed with accuracy and specificity comparable to insulin sensitivity. Physiologically-based mathematical modeling is necessary to interpret insulin secretory responses in terms of relevant parameters of β-cell function. Models can be used to analyze intravenous glucose tests, but secretory responses to intravenous glucose may be paradoxical in subjects with diabetes. Use of oral glucose (or mixed meal) data may be preferable not only for simplicity but also for physiological interpretation.     

动态比较体检人群代谢指标的研究分析

目的: 探讨体质指数( Body mass index,BMI) 与血压、血脂、血糖等的相关性,进一步论证BMI 与各代
谢指标动态变化的相互关系。方法: 回顾性分析2013 ～ 2016 882 例成年人的体检资料并进行动态比较。结果:
( 1) 第1a 男性空腹血糖受损( IFG) 、肥胖、高脂血症、高血压、高尿酸血症的患病率均高于女性( P＜0．05) ; ( 2) 第
1 a 体检人群BMI 与空腹血糖( FPG) 尚无相关关系( r = 0．194,P= 0．052) ,第4 a,两者出现了相关关系( r = 0．317,
P= 0．001) ; ( 3) 第1 a,与BMI＜24 kg /m2 组相比,BMI≥24 kg /m2 组人群TC、LDL、UA、SBP、DBP 均增高( t = －
3．75、－4．38、－0．36、－6．19、－4．55,均P＜0．05) ,HDL 降低( t = 4．05,P＜0．05) ; ( 4) 与FPG＜5．6mmol /L 组相比,FPG
≥5．6mmol /L 组UA 升高( t = －2．789,P＜0．05) ,HDL 降低( t = 2．349,P＜0．05) ; ( 5) 45～ 59 岁中年人群BMI、FPG 较
18～ 44 岁青年人群增加( F= 0．946、2．76,均P＜0．05) ; ( 6) 第4a,人群中TC 及LDL 水平较第1a 升高( t = －2．448、－
2．335,均P＜0．05) 。结论: 男性是代谢性疾病的高发人群,初始的超重对机体损害不明显,但随着时间的推移,逐
渐对人体健康产生了巨大影响。体重超标易患血压增高、IFG、高脂血症及高尿酸血症; FPG≥5．6mmol /L 人群已
存在部分代谢的改变; 年龄增加会伴随BMI、FPG 及胆固醇水平的增加。     

Do static and dynamic insulin resistance indices perform similarly in predicting pre-diabetes and type 2 diabetes?

Aims

We designed a study to compare the predictive power of static and dynamic insulin resistance indices for categorized pre-diabetes (PDM)/type 2 diabetes (DM).

Methods

Participants included 1134 adults aged 18–60 years old with normal glucose at baseline who completed both baseline and 6-years later follow-up surveys. Insulin resistance indices from baseline data were used to predict risk of PDM or DM at follow-up. Two static indices and two dynamic indices were calculated from oral glucose tolerance test results (OGTT) at baseline. Area under the receiver operating characteristic curve (AROC) analysis was used to estimate the predictive ability of candidate indices to predict PDM/DM. A general estimation equation (GEE) model was applied to assess the magnitude of association of each index at baseline with the risk of PDM/DM at follow-up.

Results

The dynamic indices displayed the largest and statistically predictive AROC for PDM/DM diagnosed either by fasting glucose or by postprandial glucose. The bottom quartiles of the dynamic indices were associated with an elevated risk of PDM/DM vs. the top three quartiles. However, the static indices only performed significantly to PDM/DM diagnosed by fasting glucose.

Conclusions

Dynamic insulin resistance indices are stronger predictors of future PDM/DM than static indices. This may be because dynamic indices better reflect the full range of physiologic disturbances in PDM/DM.     

Low circulating insulin-like growth factor-1 levels are associated with high serum uric acid in nondiabetic adult subjects

Background and aimsLow insulin-like growth factor-1 (IGF-1) levels and high uric acid concentrations are associated with cardio-metabolic disorders. Acute IGF-1 infusion decreases uric acid concentration in healthy individuals. In this study, we aimed to examine the relationship between IGF-1 and uric acid levels.Methods and results1430 adult non diabetic subjects were stratified into quartiles according to their circulating IGF-1 values. Significant differences in uric acid concentration, measured by the URICASE/POD method were observed between low (quartile 1), intermediate (quartile 2 and 3), and high (quartile 4) IGF-1 levels groups after adjusting for age, gender, and body mass index (P = 0.02). These differences remained significant after adjustment for blood pressure, total cholesterol, high density lipoprotein, triglycerides, fasting and 2 h post-load glucose levels, HOMA-IR index (P = 0.005), liver enzymes (P = 0.03), glucose tolerance status (P = 0.02), growth hormone levels (GH) (P = 0.05), anti-hypertensive treatments (P = 0.04) or diuretics use (P = 0.04)). To clarify the molecular links between IGF-1 and uric acid, we performed an in vitro study, incubating human hepatoma cells with uric acid for 24 or 48 h in the presence of GH and observed a 21% and 26% decrease, respectively, in GH-stimulated IGF-1 mRNA expression (P = 0.02 and P = 0.012, respectively). This effect appears to be mediated by uric acid ability to down regulate GH intracellular signaling; in fact we observed a significant decrease of GH activated JAK2 and Stat5 phosphorylation.ConclusionsThese data demonstrate an inverse relationship between IGF-1 and uric acid levels in adults and suggest that uric acid might affect hepatic IGF-1 synthesis.     

2009年-2011年绍兴部分人群空腹血糖变化趋势调查

目的:通过连续三年(2009年-2011年)对本市健康体检成人FPG的调查及DM、IFG分组评估,了解本市成人血糖水平趋势性变化,为预防IFG、DM的发生及治疗提供参考依据。方法:2009年-2011年体检的健康人群(31992、30141、30533例)为调查对象,从18岁～95岁,按每10岁分7个年龄组,检测FPG水平,按WHO标准对其进行统计分析。结果:2009年-2011年,FPG高水平分别是男性(5.75 mmol/L、5.96 mmol/L、6.0 mmol/L)(P<0.01),女性(5.71 mmol/L、5.82 mmol/L、5.78 mmol/L)(P<0.01),男性和女性高水平血糖均在70岁～79岁年龄段。其中IFG发生率:男性3.62%(3.97%,2.82%,4.04%),女性1.76%(2.02%,1.45%,1.80%),男性高于女性(P<0.01);DM发生率:男性5.41%,女性3.00%,总检出率4.44%(4.19%、5.08%、4.09%)。结论:FPG水平随年龄增加而升高,在一定年龄达到高峰后基本稳定,同年龄男性比女性高;IFG、DM发生率男性比女性高。     

Lactation intensity and fasting plasma lipids,lipoproteins, non-esterified free fatty acids,leptin and adiponectin in postpartum women with recent gestational diabetes mellitus: The SWIFT cohort

Objectives

Lactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates whether higher lactation intensity is related to more favorable blood lipids, lipoproteins and adipokines after GDM pregnancy independent of obesity, socio-demographics and insulin resistance.

Methods

The Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT) is a prospective cohort study that recruited 1035 women diagnosed with GDM by the 3-h 100 g oral glucose tolerance tests (OGTTs) after delivery of a live birth in 2008–2011. Research staff conducted 2-h 75 g OGTTs, and assessed lactation intensity, anthropometry, lifestyle behaviors and socio-demographics at 6–9 weeks postpartum (baseline). We assayed fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin from stored samples obtained at 6–9 weeks postpartum in 1007 of the SWIFT participants who were free of diabetes at baseline. Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models.

Results

Increasing lactation intensity showed graded monotonic associations with fully adjusted mean biomarkers: 5%–8% higher high-density lipoprotein cholesterol (HDL-cholesterol), 20%–28% lower fasting triglycerides, 15%–21% lower leptin (all trend P-values < 0.01), and with 6% lower adiponectin, but only after adjustment for insulin resistance (trend P-value = 0.04).

Conclusion

Higher lactation intensity was associated with more favorable biomarkers for type 2 diabetes, except for lower plasma adiponectin, after GDM delivery. Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance.     

新疆汉、维民族糖调节受损人群胰岛素分泌功能和胰岛素作用功能的研究

目的 评估新疆汉、维民族在IFG,IGT及IGR阶段的胰岛素分泌功能和胰岛素作用功能。 方法 采用多中心研究进行横断面调查,行OGTT试验。用胰岛素抵抗指数（HOMA-IR）评估IR,胰岛β细胞功能指数（HOMA-β）评估基础胰岛素分泌;ΔI30/ΔG30评价胰岛素早相分泌,ΔI30/ΔG30/HOMA-IR评估葡萄糖处置指数（DI）。 结果 WC、BMI、血脂、FIns、2 hIns在汉、维民族不同糖代谢组差异有统计学意义。IFG组与NGT、IGT组比较,汉、维族人群的HOMA-IR差异有统计学意义。在汉族中NGT组与IGT、IGR组比较,HOMA-β差异有统计学意义（P=0.030、0.044）,而在维族只有IFG组与NGT组比较差异有统计学意义（P=0.001）。ΔI30/ΔG30、DI在两民族不同糖代谢组差异均无统计学意义。 结论 汉族人群IR在IFG阶段,胰岛素分泌功能在IGT阶段起主要作用。IR和胰岛素分泌功能在维族人群IFG阶段起重要作用。胰岛素早相分泌及葡萄糖处置功能在糖调节受损阶段作用不显著。     

成都市区糖代谢障碍现状与相关因素的现况研究

目的 了解成都地区糖代谢障碍及有关因素的现状。方法 采取整群抽样方式调查成都市区人群7288例的人口统计学指标、社会经济因素、心血管危险因素、空腹血糖水平。结果 成都市区糖尿病知晓率22．55％，治疗率17．39％，控制率5．59％，血糖升高者约10．6万，糖尿病约6．82万，平均血糖水平女性有高于男性趋势(中年更明显)，血糖随年龄增高，≥6．1—7.0者患病率4．88％，＞7．0者患病率3．09％，血糖水平与血压、年龄、甘油三酯、胆固醇、体质指数、心率、尿酸明显相关，尤其收缩压及甘油三酯联系更强。与糖代谢障碍相关的高血压、高甘油三酯、高胆固醇及超重更为常见。结论 成都人群血糖水平、糖尿病患病率均有增高，而治疗及控制率低，血糖与多种危险因素有伴随关系，与高血压常共存，糖尿病的防治对心脑血管病防治有重大意义。     

口服葡萄糖耐量试验诊断DM、IGT、IFG的临床意义

目的　探讨空腹血糖 (FPG) <7.0mmol/L ,OGTT试验诊断糖尿病 (DM )、糖耐量减低 (IGT)及空腹血糖损害 (IFG)的价值。方法　挑选经体检确认FPG >7.0mmol/L人群作为观察对象 ,经馒头餐后 2h PG≥ 6.7mmol/L人员 ,施以OGTT ,根据 1999年WHO标准分为三组 :DM组、IGT组及IFG组。给每一组人员检查 2 4h尿微量白蛋白 (UmALB)。结果　DM、IGT及IFG男性检出率分别为 6.6%、10 .5 %及 5 .1% ,女性为 5 .1%、12 .5 %及 3 .3 % ,男性DM及IFG检出率高于女性 (P <0 .0 5 ) ,女性IGT检出率显著高于男性 (P <0 .0 1) ;2 4hUmALB ,FPG诊断DM组为 43 .2± 14 .3mg、OGTT诊断DM组为 3 0 .4± 15 .3mg、IGT组为 2 1.7± 8.5mg、IFG组为 7.7± 3 .6mg、正常对照组 7.5± 4.6mg ,DM组、IGT组均显著高于正常对照组 (P <0 .0 1) ,IFG组与正常对照组无差异 (P >0 .0 5 )。结论　对于FPG <7.0mmol/L者 ,应以OGTT试验来筛查患者是否有糖尿病或糖耐量异常。