不同状态的糖调节受损患者胰岛素分泌和胰岛素敏感性的差异

目的评估初发的单纯空腹血糖受损（IFG）和单纯糖耐量受损（IGT）患者的胰岛素分泌以及胰岛素敏感性（IS）特征。方法北京市东城区既往无糖尿病史的2388名受试者行葡萄糖耐量试验，同时行胰岛素释放试验，本文纳入2244例，其中糖耐量正常（NGT）1608例，IFG240例，IGT243例，IFG＋IGT 153例。比较各组胰岛素抵抗指数（HOMA-IR）、IS指数（Matsudaindex）、B细胞功能指数（1相Stumvoll index、△I30／△G30）。结果与NGT组比较，其余三组HOMA-IR显著升高，Matsuda指数及B细胞功能指数均显著降低（P均〈0．01）；IFG组HOMA-IR及Matsuda指数均高于IGT组；IFG组△I30／△G30高于IGT组，而Stumvoll指数低于IGT组（P〈0．01）；与IFG组、IGT组比较，IFG＋IGT组HOMA-IR显著升高，Matsuda指数、1相Stumvoll指数显著降低（P均〈0．01）。结论糖尿病前期人群存在不同程度的胰岛素分泌缺陷和IR，IFG组肝IR较重，而IGT组肌肉IR较重。

Insulin sensitivity and insulin secretion pattern is different in population with impaired glucose regulation

Objective To evaluate the metabolic characteristics of insulin secretion and insulin resistance in isolated impaired fasting glucose （IFG） and impaired glucose tolerance （IGT） and to clarify different pathophysiologies. Methods 2388 subjects aged ≥20 years from Dongcheng district in Beijing without a previous history of diabetes underwent a oral 75-g glucose tolerance test （OGTT）. The subjects were divided into 4 groups based on the results of OGTT：（1） normal glucose tolerance （NGT） ,n=608; （2） isolated impaired fasting glucose （IFG）, n=240; （3） isolated impaired glucose tolerance （IGT）,n=243; （4） combined glucose intolerance （IFG/IGT）, n=153. We compared insulin secretion and insulin sensitivity using several indexes derived from an OGTT. Results HOMA-IR was significantly increased and Matsuda index and β-cell function were significantly reduced in all subgroups of hyperglycemia vs NGT subjects（P〈0. 01）. HOMA-IR and Matsuda index were higher in lFG group than in IGT group. IFG group △I30/△G30 was higher than IGT group, however Stumvoll index was lower than IGT group（P〈 0. 01）. Subjects with IFG plus IGT exhibited a significantly higher level of insulin resistance and severe deficit in early-phase insulin secretion compared with IGT or IFG subjects （P〈0. 01）. Conclusions Prediabetic populations of IFG, IGT and both are different in the degree of insulin resistance and insulin secretion. Subjects with IFG show pronounced defect in hepatic insulin resistance, while more severe muscle insulin resistance is present in subjects with IGT.