正常糖调节人群早期相胰岛素分泌与血糖波动的关系

目的 探讨正常糖调节者早期相胰岛素分泌与血糖波动水平的关系.方法 应用动态血糖监测系统对全国10个中心339名正常体质量、正常糖调节者[年龄20～69岁,男169名,女170名,体重指数(22.2±2.2)kg/m2]进行动态血糖监测(CGM)、75 g 口服葡萄糖耐量试验及胰岛素释放试验,采用CGM监测结果计算得到的平均血糖波动幅度(MAGE)评估血糖波动,以△I30/△G30评估糖负荷后早期相胰岛素分泌,以稳态模式分析法(HOMA)评价基础胰岛素抵抗(HOMA-IR)和胰岛β细胞分泌功能(HOMA-β),以Cederhom公式计算的胰岛素敏感性指数(ISIc)评估糖负荷后胰岛素敏感性.结果 (1)339名正常人MAGE水平为(1.92±0.89)mmol/L,根据MAGE四分位间距将正常人分为四组,分别是A组83名(MAGE<1.33 mmol/L)、B组85名(MAGE 1.33～1.72 mmol/L)、C组86名(MAGE 1.73～2.41 mmol/L)及D组85名(MAGE>2.41 mmol/L).校正年龄、性别及HOMA-IR后,A、B组△I30/△G30水平高于C、D组(P<0.05或0.01),而四组间HOMA-β的差异均无统计学意义(P>0.05).(2)胰岛素敏感性方面,无论是HOMA-IR还是ISIc,四组之间的差异均无统计学意义(P>0.05).(3)Spearman相关分析显示:MAGE水平与年龄呈正相关(r=0.157,P=0.004),与△I30/△G30呈负相关(r=-0.270,P<0.001).逐步多元回归分析显示:△I30/△G30与MAGE水平呈独立负相关(β=-0.246,P<0.001).结论 正常糖调节者血糖波动水平与早期相胰岛素分泌功能密切相关.

Relationship between early-phase insulin secretion and blood glucose variability in subject with normal glucose regulation

Objective To investigate the relationship between early-phase insulin secretion and blood glucose variability in subject with normal glucose regulation. Methods Three hundred and thirty-nine individuals with normal body weight and normal glucose regulation, including 169 males and 170 females ranging from 20 to 69 years, were recruited from 10 hospitals in China. The mean amplitude of glycemic excursions (MAGE) observed by continuous glucose monitoring system was used assessing blood glucose variability. △I30/△G30 during oral glucose tolerance test was used to assess early-phase insulin secretion,whereas baseline insulin secretion by HOMA-β. Insulin sensitivity was evaluated by HOMA-IR and insulin sensitivity index (ISIc) resulting from Cederhum formula. Results The mean of MAGE in 339 normal subjects was (1.92±0. 89) mmol/L. According to quartiles of MAGE, the subjects were divided into 4 groups, namely the Group A (MAGE < 1.33 mmol/L), Group B (MAGE 1.33～1.72 mmol/L), Group C (MAGE 1.73～2. 41 mmol/L), and Group D (MAGE >2. 41 mmol/L). Adjustment for age, sex and HOMA-IR, the △I30/△G30 levels of Group A and B were both higher than those of Group C and D (P< 0. 05). There were no difference in HOMA-β, HOMA-IR and ISIc levels among the four groups (P> 0.05). Spearman correlation analysis showed that the MAGE level was positively correlated with age (r=0.157, P=0.004), and negatively correlated with △I30/△G30 (r =-0.270, P < 0. 001). Multiple regression analysis indicated that the △I30/△G30 was the independent influential factor of MAGE (β=-0.246, P < 0. 001). Conclusion The blood glucose excursions in subject with normal glucose regulation may be closely related to the function of early-phase insulin secretion.