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目的:研究2型糖尿病进展过程中胰岛β细胞功能和胰岛素敏感性的变化特点。方法:将113例2型糖尿病患者按照糖尿病病程分3组:A组(<5年)、B组(5～9年)和C组(≥10年)。所有患者均做100 g标准馒头餐试验,测定血糖及胰岛素水平。结果:(1)C组与A组比较空腹血糖水平显著升高(P<0.01)。B组和C组负荷后1,2,3 h血糖均高于A组(P<0.05)。C组负荷后3 h血糖较B组有显著升高(P<0.05)。(2)C组负荷后1 h和2h胰岛素分泌水平降低(P<0.05),胰岛β细胞分泌功能(HOMA-β)显著下降(P<0.01),但胰岛素分泌曲线下面积(AUC)仅与A组有显著性差异(P<0.001)。(3)负荷后胰岛素与基础胰岛素比值(INS1～3/INS0)的特点为C组INS1/INS0和INS2/INS0比值减低(P<0.05)。此外,相关性分析发现,INS1/INS0和INS2/INS0比值分别与空腹血糖、β细胞功能显著相关(P<0.05或P<0.01)。结论:2型糖尿病患者胰岛β细胞继续发生变化,C组胰岛β细胞分泌胰岛素的水平和反应性显著下降。
Objective: To investigate the changes of pancreatic β-cell function and insulin sensitivity during the progression of type 2 diabetes mellitus. Methods: 113 patients with type 2 diabetes were divided into 3 groups according to their duration of diabetes: group A (<5 years), group B (5-9 years) and group C (≥10 years). All patients were 100 g standard bread meal test, determination of blood glucose and insulin levels. Results: (1) Compared with group A, fasting blood glucose level was significantly increased in group C (P <0.01). Blood glucose of group B and C were higher than that of group A at 1, 2 and 3 h after loading (P <0.05). Blood glucose in group C at 3 h after loading was significantly higher than that in group B (P <0.05). (2) The level of insulin secretion at 1 h and 2 h (P <0.05) and HOMA-β decreased significantly in group C (P <0.01), but the area under the curve of insulin secretion (AUC) Group A had significant difference (P <0.001). (3) The ratio of post-load insulin to basal insulin (INS1-3 / INS0) was decreased in INS1 / INS0 and INS2 / INS0 in group C (P <0.05). In addition, the correlation analysis found that INS1 / INS0 and INS2 / INS0 ratio were significantly associated with fasting blood glucose and β-cell function (P <0.05 or P <0.01). CONCLUSION: The islet β cells continue to change in patients with type 2 diabetes, while the insulin secretion and reactivity of pancreatic β cells in group C are significantly decreased.