肥胖及非肥胖首诊2型糖尿病患者胰岛素分泌、胰岛素抵抗情况及干预效果分析

目的研究肥胖及非肥胖首诊2型糖尿病（T2DM）患者胰岛功能情况及降糖药物的干预效果。方法选择本院2011年3月~2012年3月收治的首诊T2DM患者200例为研究组,选择同期糖耐量正常的80例健康者为对照组,两组对象均根据体质量指数分为肥胖组（BMI≥24 kg/m2）及非肥胖组（BMI〈24 kg/m2）,两组对象均行口服糖耐量实验（OGTT）,测定患者空腹,餐后30、60、120 min血糖及胰岛素水平,并计算胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（SEN）,β细胞功能指数（HOMA-β）,早期分泌指数（△I30/△G30）;糖尿病患者给予格列齐特干预治疗1~3个月,干预后测量患者血糖及胰岛功能的改变情况。结果研究组和对照组中,肥胖患者HOMA-IR均明显高于非肥胖患者,且研究组整体HOMA-IR高于对照组,差异有统计学意义（P〈0.05）。研究组患者中,在不同血糖水平上,肥胖组患者SEN均低于非肥胖组,差异有统计学意义（P〈0.05）,但△I30/△G30及HOMA-β要优于同一血糖水平的非肥胖患者。药物干预后肥胖患者HOMA-β和△I30/△G30变化差值明显高于非肥胖者,SEN变化差值低于非肥胖患者,差异均有统计学意义（均P〈0.05）。结论对于首诊T2DM患者,肥胖可加强胰岛素抵抗状态和胰岛素分泌,并且胰岛功能随着空腹血糖水平的升高而恶化,药物干预血糖水平可使肥胖患者分泌功能显著恢复,而非肥胖患者敏感性恢复更明显。

Analysis of insulin secretion,insulin resistance and intervention effects for obese and non-obese patients with initial diagnosis of type-2 diabetes mellitus

Objective To study the islet function and the intervention effects of hypoglycemic drugs for obese and non-obese patients with the initial diagnosis of type-2 diabetes mellitus(T2DM).Methods 200 patients with the initial diagnosis of T2DM in our hospital from March 2011 to March 2012 were selected as study group and 80 healthy people with normal glucose tolerance in the corresponding period were selected as control group.Both groups of study subjects were divided into the obese group(BMI≥24 kg/m2) and the non-obese group(BMI<24 kg/m2).The glucose and insulin levels during fasting and 30,60 and 120 minutes after dinner were determined using the oral glucose tolerance test(OGTT).The homeostasis model assessment of insulin resistance(HOMA-IR),insulin sensitivity index(SEN),homeostasis model assessment of β cell function(HOMA-β) and early secretion index(△I30/△G30) were also calculated.The patients with diabetes mellitus received the interventional treatment with Gliclazide for 1 to 3 months,after which the glucose and islet function changes of the patients were determined.Results In both the study group and the control group,obese patients had significantly higher HOMA-IR than non-obese patients,and the study group as a whole had significantly higher HOMA-IR than the control group,with statistically significant differences(P < 0.05).In the study group,obese patients had lower SEN than non-obese patients at various glucose levels,with statistically significant differences(P < 0.05),but had better △I30/△G30 and HOMA-β than non-obese patients at the same glucose level.After drug intervention,obese patients had significantly larger △I30/△G30 and HOMA-β changes and lower SEN change than non-obese patients,there were significant differences(all P < 0.05).Conclusion For the patients with the initial diagnosis of type-2 diabetes mellitus,obesity can enhance insulin resistance and insulin secretion,and the islet function devastates with the elevation of fasting plasma glucose level.Drug intervention of the glucose level can significantly restore the secretory function of obese patients and the sensitivity recovery of non-obese patients is more significant.