上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (8): 940-.doi: 10.3969/j.issn.1674-8115.2018.08.014

• 论著·临床研究 • 上一篇    下一篇

新诊断标准下糖尿病前期人群胰岛 β细胞功能和胰岛素敏感性的特点分析

贺星星，马晓静，应令雯，朱玮，顾程晨，唐峻岭，王煜非，包玉倩，周健   

  1. 上海交通大学附属第六人民医院内分泌代谢科，上海市糖尿病临床医学中心，上海市糖尿病研究所，上海市糖尿病重点实验室，上海 200233
  • 出版日期:2018-08-28 发布日期:2018-09-11
  • 通讯作者: 周健，电子信箱：zhoujian@sjtu.edu.cn。
  • 作者简介:贺星星（1993—），女，硕士生；电子信箱： dbxx20130201@163.com。
  • 基金资助:
    上海市教育委员会高峰高原学科建设计划（20161430）

Characteristic analysis of insulin secretion and sensitivity in pre-diabetes populations under new diagnostic criteria

HE Xing-xing, MA Xiao-jing, YING Ling-wen, ZHU Wei, GU Cheng-chen, TANG Jun-ling, WANG Yu-fei, BAO Yu-qian, ZHOU Jian   

  1. Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Department of Endocrinology and Metabolism, Shanghai Sixth Peoples Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2018-08-28 Published:2018-09-11
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Support，20161430

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摘要： 目的 ·评估不同类型糖尿病前期人群的胰岛 β细胞功能、胰岛素敏感性及血糖处置能力。方法 ·共纳入 1 317例研究对象，其中糖耐量正常（ normal glucose tolerance，NGT）382例，糖尿病前期 935例。依据 2010年美国糖尿病学会糖尿病前期的诊断标准，将糖尿病前期人群分为 7个亚组。以稳态模型分析（ homeostasis model assessment，HOMA）来评估基础胰岛 β细胞分泌功能（HOMA-β）及胰岛素敏感性（ HOMA-IR），以 0～ 120 min胰岛素曲线下面积 /血糖曲线下面积（ area under curve for insulin/area under curve for glucose，AUCINS120/AUCGLU120）来评估糖负荷后胰岛 β细胞分泌功能，以 Cederholm公式计算的胰岛素敏感性指数（insulin sensitivity index，ISI）来评估糖负荷后胰岛素敏感性。计算血糖处置指数（ disposition index，DI）来反映血糖处置能力。结果 ·糖尿病前期人群中最常见的类型为空腹血糖受损（impaired fasting glucose，IFG）合并糖耐量受损（impaired glucose tolerance，IGT）合并糖化血红蛋白（ glycated hemoglobin A1c，HbA1c）5.7%～ 6.4%，其次为单纯 IGT，而单纯 IFG占比最低。单纯 HbA1c 5.7%～ 6.4%组胰岛素敏感性优于单纯 IFG、单纯 IGT、IFG合并 IGT亚组（均 P<0.05），胰岛 β细胞功能与其他亚组类似。单纯 HbA1c 5.7%～ 6.4%组 DI约是单纯 IGT及 IFG合并 IGT组的 1.5倍（均 P0.000），与单纯 IFG组差异无统计学意义。无论 IFG、IGT还是 IFG合并 IGT人群，如合并 HbA1c 5.7%～ 6.4%，则其胰岛 β细胞功能或胰岛素敏感性进一步下降。结论 ·新标准下不同类型糖尿病前期人群存在明显异质性，HbA1c 5.7%～ 6.4%是否适用于中国人群作为糖尿病前期的诊断标准，尚需大样本的前瞻性研究来证实。

关键词: 糖尿病前期, 胰岛 &, beta, 细胞功能, 胰岛素敏感性, 糖化血红蛋白, 处置指数

Abstract:

Objective · To investigate the characteristics of insulin secretion function and sensitivity and blood glucose disposition capacity in the pre-diabetes populations. Methods · A total of 1 317 subjects were enrolled in this study, including 382 with normal glucose tolerance (NGT) and 935 with pre-diabetes. All pre-diabetes populations were divided into seven subgroups according to the cut-off points of 2010 American Diabetes Association standards. Homeostasis model assessment (HOMA) was used to access baseline insulin secretion (HOMA-β) and insulin sensitivity (HOMA-IR). Insulin secretion and sensitivity after glucose load were evaluatedarea under curve (AUC) for insulin/AUC for glucose (AUCINS120/AUCGLU120) and insulin sensitivity index (ISI) calculated Cederholm formula, respectively. Disposition index (DI) was used to reflect blood glucose disposition capacity. Results · The most common type of pre-diabetes was impaired fasting glucose (IFG) combined with impaired glucose tolerance (IGT) and glycated hemoglobin A1c (HbA1c)5.7%-6.4%, followedisolated IGT, while the proportion of isolated IFG was the lowest. The insulin sensitivity of isolated HbA1c 5.7%-6.4% group was better than that of isolated IFG group, isolated IGT group, and IFG combined with IGT group (P<0.05). And its β-cell function was similar with the other subgroups. The DI value of isolated HbA1c 5.7%-6.4% group was about 1.5 times of that of isolated IGT group and IFG combined with IGT group (P0.000), which was similar with isolated IFG group. The function of β cell or insulin sensitivity in the pre-diabetes subjects with HbA1c 5.7%-6.4% was further damaged compared with the pre-diabetes people whose HbA1c were lower than 5.7%. Conclusion · Different types of pre-diabetes are significantly heterogeneous under new diagnostic criteria, and further prospective studies with a larger sample size are needed to clarify whether HbA1c 5.7%-6.4% is suias a diagnostic criteria for pre-diabetes in Chinese population.

Key words: pre-diabetes, pancreatic &, beta, -cell function, insulin sensitivity, glycated hemoglobinA1c (HbA1c), dispositionindex (DI)

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