摘要/Abstract

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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