摘要目的 通过对中老年人群不同糖代谢状态进行调查分析,研究不同胰岛素水平对于糖耐量低减(IGT)患者向2型糖尿病(T2DM)转变的影响.方法 研究对象为2005-2007年在解放军总医院体检的北京居民,并根据口服葡萄糖耐量试验(OGTT)结果将人群分为正常糖耐量-非高胰岛素血症( NGT-NHIns)、糖耐量低减-高胰岛素血症(IGT-HIns)、糖耐量低减-非高胰岛素血症(IGT-NHIns)3组,以2009-2010年随访作为结点观察3组人群的转归情况.高胰岛素血症以空腹胰岛素≥15 mU/L和(或)糖负荷后2h胰岛素水平≥80 mU/L作为诊断标准.结果 IGT-NHIns组转变成T2DM的比例(42/133)较IGT-HIns( 24/154)、NGT-NHIns( 12/126)组要高.IGT-NHIns组稳态模型评估的胰岛素抵抗指数( HOMA-IR)比IGT-HIns组低[0.96 (0.40,3.53)比2.04(0.59,23.20),P＜0.05],但是全身胰岛素敏感性指数(WBISI)却要高于IGT-HIns组[7.48(3.20,31.35)比3.28(0.86,7.67),P＜0.05]；在评价β细胞功能方面,IGT-NHIns组新β细胞功能指数(MBCI)和胰岛素分泌指数(ISI)分别比IGT-HIns组差得多[2.57(0.58,10.98)比5.17(1.04,65.09)；7.66(0.99,28.40)比17.56(4.18,96.46),P值均＜0.01].结论 IGT-NHIns状态者发展到T2DM的风险高于IGT-HIns.预防IGT向糖尿病的转变,除了关注高胰岛素血症的危险外,对于胰岛素水平正常的IGT人群更应引起重视,早期加强危险因素控制有利于保护β细胞功能,延缓向糖尿病发展的进程.

abstractsObjective To study the impact of different insulin levels on the conversion from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM),through analysis of different glycometabolism condition among quinquagenarian population.Methods Subjects enrolled were Beijing habitants who received annual physical examination [ including oral glucose tolerance test (OGTI) ] in the Chinese PLA General Hospital from 2005-2007.According to the OGTT results,the subjects were divided into three groups,including normal glucose tolerance-non-hyperinsulinemia group (NGT-NHIns),IGT-hyperinsulinemia group (IGT-Hins) and IGT-non-hyperinsulinemia group (IGT-NHINS).The prognosis between the year 2009 and 2010 of the three groups was observed.Hyperinsulinemia was diagnosed with fasting serum insulin ≥ 15 mU/L and/or 2-hour serum insulin ≥ 80 mU/L after glucose loading.Results The rate of case number of conversion to T2DM in IGT-NHIns group (42/133) was higher than that in IGT-Hins group (24/154) or NGT-NHIns group (12/126).The HOMA insulin resistance index (HOMAIR) of individuals with IGT-NHIns was lower than that of IGT-Hins [ 0.96 (0.40,3.53 ) vs 2.04 (0.59,23.20),P ＜ 0.05 ],while whole body insulin sensitivity index (WBISI) was higher than that of IGT-Hins [ 7.48 (3.20,31.35 ) vs 3.28 ( 0.86,7.67 ),P ＜ 0.05 ].Modified β-cell function index ( MBCI ) and insulin secretion index (ISI) in IGT-NHIns was poorer than that of IGT-Hins respectively [ 2.57 (0.58,10.98) vs5.17(1.04,65.09); 7.66 (0.99,28.40) vs 17.56 (4.18,96.46),allPvalues ＜0.01].Conclusions The risk of IGT-NHIns progressing into T2DM is higher than that of IGT-Hins. For the prevention of T2DM,individuals with IGT-NHIns should be paid more attention than keeping an eye on IGT-Hins patients.Early control of risk factors could protect β cell function and prevent the progression to T2DM.