3312 * ( 210008) 2 57 OGTT NGT IGT IFG+IGT T2DM IVGTT HOMA-IR [DI1= HOMA-β/HOMA-IR DI2=ΔI 30 /ΔG 30 /HOMA-IR DI3=MBCI IAI DI4= AIR 0-10 /HOMA-IR] AUC INS /HOMA-IR IGT IFG+IGT T2DM HOMA-IR P>0.05 NGT P<0.05 IGT IFG+IGT T2DM DI1 P<0.05 NGT IGT DI1 P>0.05 NGT IGT IFG+IGT T2DM DI2 DI3 DI4 P<0.05 IFG+IGT T2DM OGTTAUCINS/HOMA-IR P<0.05, NGT P<0.05 NGT IGT OGTTAUC INS /HOMA-IR P>0.05 1 IGT 1 IFG+IGT 1 2 T2DM 2 T2DM 3 1 T2DM 4 IFG+IGT 2 R587.1 A 1673-6273 2012 17-3312-05 The Variances of Islet β-cell Function at Different Stages of Glucose Metabolism* YU Ting-ting, HU Yun, WANG Chun, HUANG Hong, TONG Guo-yu, YANG Dong-hui, ZHU Da-long (Department of Geriatrics, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, 210008, China) ABSTRACT Objective: To guide the early diagnosis of type 2 diabetes mellitus (T2DM) by investigating the differences of insulin secretion and insulin sensitivity at differert stages from nomal glucose tolerance (NGT) to T2DM. Methods: A total of 57 Chinese adults were divided into NGT, isolated impaired glucose tolerance (IGT), combined impaired fasting glucose and impaired glucose tolerance (IFG plus IGT), and newly-diagnosed T2DM according to oral glucose tolerance test (OGTT), then were given to an intravenous glucose tolerance test (IVGTT) and insulin release test. Insulin sensitivity was measured by homeostasis model assessment of insulin resistance (HOMA-IR); The islet β-cell function was evaluated by disposition indices[di1=homa-β/homa-ir, DI2=ΔI 30 /ΔG 30 /Homa-IR, DI3= MBCI IAI, DI4= AIR 0-10 /Homa-IR] and insulin area under curve of OGTT (AUC INS ) /Homa-IR. Results: HOMA-IR in IGT IFG plus IGT and newly-diagnosed T2DM groups were significantly higher than that of NGT (P<0.05), but there was no significant difference among IGT IFG plus IGT and newly-diagnosed T2DM (P>0.05). DI1 was gradually decreased from IGT through IFG plus IGT to newly-diagnosed T2DM (P<0.05) but there was no significant difference between NGT and IGT(P>0.05). DI2, DI3, DI4 were gradually decreased from NGT through IGT, IFG plus IGT to newly-diagnosed T2DM (P<0.05). but there was no significant difference between NGT and IGT (P>0.05). OGTTAUC INS /HOMA-IR was gradually decreased from IFG plus IGT to newly-diagnosed T2DM (P<0.05) but there was no significant difference between NGT and IGT (P>0.05). Conclusions:(1) Insulin resistance and the decline of first-phase, early-phase of insulin secretion existed in IGT at the same time. The decline of first-phase, early-phase of insulin secretion aggravated in IFG plus IGT, and impairment of basic-phase,second-phase of insulin secretion occurred, but the decrease of insulin sensitivity was not obvious. The dysfunction of all phase of insulin secretion existed in newly-diagnosed T2DM, but the decrease of insulin sensitivity was also not obvious. (2) β-cell function defection may play more important role during the development of T2DM. (3)Insulin sensitivity,firstphase and early-phase insulin secretion were predict factors of T2DM. (4) IFG plus IGT needed active intervention. Key words: Type 2 diabetes mellitus; Impaired glucose tolerance; Impaired fasting glucose; Nsulin sensitivity; Insulin secretion Chinese Library Classification(CLC): R587.1 Article ID: 1673-6273 2012 17-3312-05 Document code: A * YKK0447 1982-025-83106666-30301 013390799892 E-mail cathytina_2000@sina.com E-mail zhudldr@gmail.com 2012-03-06 2012-04-16
3313 MBCI( β ) = (G 0 I 0 )/( G 60 + G 120-7.0) Bergman 2 type 2 diabetes mellitus,t2dm (disposition index DI ) DI1= HOMA-β/ [1] β HOMA -IR DI2= I 30 / G 30 / HOMA-IR DI3= MBCI IAI DI4= [2-4] T2DM AIR 0-10 / HOMA -IR 4 β IR impai- red fasting glucose IFG impaired glucose tolerance IGT IFG IGT IFG IGT T2DM ± x±s 1.3.2 SPSS 13.0 IFG IGT T2DM IFG IGT one-way BMI 2 [5] IGT T2DM SNK [6] T2DM one-way β BMI P<0.05 2 1 1.1 57 OGTT 2.2 OGTT 1 1999 WHO NGT 12 2.3 IVGTT 2 IGT 13 IFG+IGT 10 T2DM 22 2.4 NGT IGT IFG+IGT T2DM 3 T2DM IGT NGT HOMA-IR P<0.05 (GAD) ( ICA) DI2 DI3 DI4 P<0.05 OGTTAUC INS /HOMA-IR 1.2 1.2.1 57 (BMI) (WHR) 1.2.2 3 150g 05 DI1 DI2 DI3 DI4 OGTTAUC INS /HOMA-IR 10 75g P<0.05 IFG+IGT OGTT (IRT) 0 30 60 1 2 120min IFG+IGT IGT DI1 DI2 DI3 DI4 (TG) (TC) (HDL) P<0.05 IFG+IGT 1 (LDL) A(ApoA) B(ApoB) (BUN) (Cr) (UA) (GPT) (GOT) A1C (A1C) 1.2.3 25g 1 2 IVGTT IRT 3min 0min T2DM NGT HOMA-IR P<0.05 1 2 4 6 10 min IGT IFG+IGT P>0.05 1.2.4 BMI NGT 100% CV2.8% CV3.4% IGT DI1 DI2 DI3 DI4 OGTTAUC INS /HOMA-IR (Enzyme linked immunosorbent assay ELISA) NGT 78% 19% 35% 36% 79% IFG+IGT Mercodia CV1.7% CV3.5% 1.3 1.3.1 β HOMA-IR 3 = (G0) (I0) /22.5 1 IR β 2 HOMAβ = 20 I 0 / (G 0-3.5) AIR 0-10 = I 0 +I 1 +I 2 +I 4 +I 6 +I 10 OGTT insulin area under curve, AUC I 2.1 NGT IGT IFG+IGT T2DM 1 IGT 1 2 IFG+IGT NGT HOMA-IR P<0. IGT T2DM NGT IGT IFG+IGT DI1 DI2 DI3 DI4 P<0.05, T2DM NGT 23% 7% 26% 15% 49% T2DM NGT 13% 4% 17% 7% 30% Homa-IR IAI [7] I 30 / G 30 = (I 30 -I 0 )/(G 30 -G 0 ) HOMA-β OGTTAUCI I 30 / G 30
3314 [8] MBCI OGTT120min β OGTT [9] [10] AIR 0-10 1 OGTT (DI) β IR 2 IR β 1 x±s Table 1 Comparison of clinical characteristics among groups x±s NGT IGT IFG+IGT T2DM P values Number 12 13 10 22 - Gender(M/F) 7/5 7/6 5/5 12/10 - Age(years) 39.5±9.3bcd 50.4±8.4a 53.9±6.1a 53.7±12.2a 0.001 BMI(kg/m 2 ) 22.7±2.1bcd 25.3±2.2a 24.8±3.1a 25.7±2.8a 0.018 WHR 0.84±0.05bd 0.89±0.04a 0.87±0.06 0.91±0.05a 0.001 SBP(mmHg) 116.3±17.9 122.3±13.2 125.8±12.8 126.3±16.0 0.435 DBP(mmHg) 77.5±12.0 80.8±8.4 86.9±9.2 80.3±9.8 0.270 TG(mmol/L) 1.3±0.5 2.6±2.3 1.9±1.0 2.9±2.4 0.118 TC(mmol/L) 4.4±0.4 5.0±1.0 5.3±1.3 4.5±1.4 0.154 HDL (mmol/l) 1.0±0.2 1.2±0.3 1.0±0.2 0.066 LDL (mmol/l) 2.3±0.3 2.7±0.6 2.7±1.0 2.7±0.9 0.428 Apo A(mmol/L) 1.1±0.2 1.2±0.2 1.3±0.3 1.2±0.3 0.322 Apo B(mmol/L) 0.8±0.1 0.9±0.3 0.056 BUN((mmol/L) 5.2±1.2 5.5±1.5 6.2±1.1 6.2±1.6 0.199 Cr(μmol/L) 77.9±11.6 69.6±12.0 71.2±11.7 77.6±9.3 0.109 UA(mmol/L) 359.4±92.1 323.9±85.5 383.3±123.7 333.2±79.3 0.392 GPT(U/L) 33.2±14.6 36.6±20.3 28.0±8.9 40.5±24.5 0.405 GOT(U/L) 28.1±11.4 28.0±10.6 22.1±6.3 30.5±14.4 0.334 A1C(%) 5.1±0.3d 5.8±0.4d 6.2±0.4d Note a P<0.05,vs NGT b P<0.05,vs IGT c P<0.05,vs IFG+IGT d P<0.05 vs T2DM. 8.3±1.8abc 0.000 1 OGTT Fig.1 Plasma glucose and serum specific insulin levels at different time points during OGTT Note: a P<0.05, vs NGT; b P<0.05, vs IGT; c P<0.05, vs IFG+IGT;d P<0.05 vs T2DM. Diamonds, NGT; Squares, IGT; Triangles, IFG plus IGT; Circles, newly-diagnosed T2DM.
3315 2 IVGTT Fig.2 Sserum specific insulin levels at different time points during IVGTT Note: a P<0.05, vs NGT; b P<0.05, vs IGT; c P<0.05, vs IFG+IGT; d P<0.05 vs T2DM. Diamonds, NGT; Squares, IGT; Triangles, IFG plus IGT; Circles, newly-diagnosed T2DM. 3 Fig.3 Comparision of islet β-cell function among groups Note: a P<0.05, vs NGT; b P<0.05, vs IGT; c P<0.05, vs IFG+IGT; d P<0.05 vs T2DM. [11] HOMA-IR HOMA-β HOMA-IR I 30 / G 30 IAI MBCI HOMA-IR AIR0-10 13% BMI β β NGT IGT IFG+IGT T2DM IR HOMA-IR T2DM β T2DM HOMA-β β DI1 DI2 DI3 DI4 1 2 [12] OGTTAUC INS /HOMA-IR 3 IR β T2DM 1 IGT 2 [13] UKPDS 1 2 T2DM β 50% 1 2
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