论文部分内容阅读
目的:研究糖尿病不同发展阶段胰岛素敏感性及胰岛素分泌功能的改变,指导2型糖尿病的早期诊断。方法:57例行OGTT体检者,分为NGT、IGT、IFG+IGT、新诊断T2DM四组,并行IVGTT,采用HOMA-IR评估胰岛素敏感性,采用葡萄糖处置指数[DI1=HOMA-β/HOMA-IR,DI2=ΔI30/ΔG30/HOMA-IR,DI3=MBCI×IAI,DI4=AIR0-10/HOMA-IR]及AUCINS/HOMA-IR评估胰岛素分泌功能。结果:IGT、IFG+IGT、新诊断T2DM组HOMA-IR无统计学差异(P>0.05),均显著高于NGT组(P<0.05)。IGT、IFG+IGT、新诊断T2DM组DI1逐步降低(P<0.05);NGT、IGT组DI1无统计学差异(P>0.05)。NGT、IGT、IFG+IGT、新诊断T2DM组DI2、DI3、DI4逐步降低(P<0.05)。IFG+IGT、新诊断T2DM组OGTTAUCINS/HOMA-IR逐步降低(P<0.05),且显著低于NGT组(P<0.05);NGT、IGT组OGTTAUCINS/HOMA-IR无统计学差异(P>0.05)。结论:(1)IGT阶段胰岛素抵抗及胰岛素1相、早期相分泌功能的下降同时存在。IFG+IGT阶段胰岛素1相、早期相分泌进一步下降,并出现基础相、2相分泌的减少,胰岛素抵抗加重不明显。新诊断T2DM阶段胰岛素各相分泌进一步减少,胰岛素抵抗加重不明显。(2)在T2DM发生过程中,胰岛素分泌功能下降较胰岛素敏感性下降更为明显。(3)胰岛素抵抗及胰岛素1相、早期相分泌功能的下降是T2DM的预测因子。(4)IFG+IGT阶段应积极干预。
Objective: To study the changes of insulin sensitivity and insulin secretion in different stages of diabetes and to guide the early diagnosis of type 2 diabetes mellitus. Methods: Fifty-seven subjects with OGTT were divided into NGT, IGT, IFG + IGT, newly diagnosed T2DM group and IVGTT. HOMA-IR was used to evaluate insulin sensitivity. Glucose-treated index [DI1 = HOMA- β / HOMA- IR, DI2 = ΔI30 / ΔG30 / HOMA-IR, DI3 = MBCI × IAI, DI4 = AIR0-10 / HOMA-IR] and AUCINS / HOMA-IR were used to assess insulin secretion function. Results: HOMA-IR in IGT, IFG + IGT and newly diagnosed T2DM group was not significantly different (P> 0.05), which were significantly higher than that in NGT group (P <0.05). IGT, IFG + IGT, DI1 in newly diagnosed T2DM group were gradually decreased (P <0.05), while there was no significant difference in DI1 between NGT and IGT group (P> 0.05). NGT, IGT, IFG + IGT, DI2, DI3 and DI4 in newly diagnosed T2DM group decreased gradually (P <0.05). The levels of OGTTAUCINS / HOMA-IR in the newly diagnosed T2DM group were significantly lower than those in the NGT group (P <0.05), but were no significant difference between NGT group and IGT group (P> 0.05) ). Conclusion: (1) IGT phase insulin resistance and insulin 1 phase, the decline of early phase secretion exist. Phase 1 IFG + IGT phase, early phase secretion further decline, and the underlying phase, 2 phase secretion decreased, insulin resistance aggravated no significant. New diagnosis of T2DM phase insulin secretion further reduced each phase, insulin resistance aggravate was not obvious. (2) In the process of T2DM, the decrease of insulin secretion was more obvious than that of insulin sensitivity. (3) Insulin resistance and insulin 1 phase, the decline in early phase secretion is a predictor of T2DM. (4) IFG + IGT stage should actively intervene.