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目的评估新诊断2型糖尿病患者一相胰岛素分泌与胰岛素敏感性。方法对332例新诊断2型糖尿病患者按照精氨酸刺激试验的结果分为胰岛功能正常组和异常组来评估其胰岛素分泌和胰岛素敏感性的状况。结果(1)胰岛功能正常组的体重、体重指数(BMI)、腰围、臀围、股围、空腹血清真胰岛素和甘油三酯均显著高于胰岛功能异常组(均P<0.01);(2)校正性别、年龄、BMI和腰臀比后,胰岛功能正常组的真胰岛素增值(△TI)和胰岛素抵抗指数(HOMA-IR)均显著高于胰岛功能异常组(均P<0.01);(3)胰岛素分泌功能正常伴胰岛素抵抗的个体,胰岛素分泌功能正常不伴胰岛素抵抗的个体,胰岛素分泌功能缺陷伴胰岛素抵抗的个体和胰岛素分泌功能缺陷不伴胰岛素抵抗的个体分别占总人数的35.11%、5.02%、29.78%和30.09%。结论2型糖尿病个体可分为单纯胰岛功能异常、单纯胰岛素抵抗及胰岛功能异常伴胰岛素抵抗3类,其诊断和治疗需依据此病理生理状态的评估。
Objective To evaluate the first-phase insulin secretion and insulin sensitivity in newly diagnosed type 2 diabetic patients. Methods According to the results of arginine stimulation test, 332 cases of newly diagnosed type 2 diabetes patients were divided into normal group and abnormal group to evaluate their insulin secretion and insulin sensitivity. Results (1) Body weight, body mass index (BMI), waist circumference, hip circumference, femoral circumference, fasting serum true insulin and triglyceride in normal pancreatic function group were significantly higher than those in dysfunction group (all P <0.01) ) After adjusting for gender, age, BMI and waist-to-hip ratio, the real insulin positive rate (△ TI) and insulin resistance index (HOMA-IR) were significantly higher in the islet dysfunction group (all P <0.01) 3) Individuals with normal insulin secretion and insulin resistance, individuals with normal insulin secretion without insulin resistance, individuals with insulin secretion deficit and insulin resistance, and individuals with insulin secretion deficiency without insulin resistance account for 35.11% , 5.02%, 29.78% and 30.09% respectively. Conclusion Individuals with type 2 diabetes mellitus can be divided into three groups: simple islet dysfunction, simple insulin resistance and islet dysfunction with insulin resistance. The diagnosis and treatment should be based on the assessment of pathophysiological status.