Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes
Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes
复制标题
DOI：
10.1016/j.atherosclerosis.2008.12.006
复制
发表时间：
2009-07-01
期刊：
影响因子：
5.3
通讯作者：
Huh, Kap Bum
中科院分区：
文献类型：
--
作者：
Park, Seok Won;Kim, Soo Kyung;Huh, Kap Bum
目的：胰岛素抵抗可能是2型糖尿病与心血管疾病之间的重要联系。然而，目前尚不清楚胰岛素抵抗本身或高胰岛素血症是否与亚临床动脉粥样硬化独立相关。我们假设胰岛素抵抗而不是高胰岛素血症与2型糖尿病患者的颈动脉粥样硬化有关。方法：我们检查了2471名在赫尔糖尿病中心连续登记的2型糖尿病患者。采用短胰岛素耐量试验，以血糖消失速率常数(KITT)直接评价胰岛素敏感性。空腹胰岛素水平作为高胰岛素血症的标志。对双侧颈动脉进行B型超声检查。颈动脉粥样硬化的定义是有明显孤立的斑块或平均颈动脉内中膜厚度(IMT)=1.1 mm。结果：在多元回归模型中，胰岛素敏感性指数(KIT)与颈动脉IMT显著相关，而高胰岛素血症与颈动脉IMT显著相关，这些危险因素包括年龄、性别、BMI、吸烟、收缩压、高密度脂蛋白和低密度脂蛋白。KIT的一个标准差降低与颈动脉内膜厚度增加0.046 mm相关(p=0.015)。此外，在调整了已知危险因素的胰岛素抵抗(胰岛素敏感性的最低四分位)的2型糖尿病患者中，颈动脉粥样硬化的优势比为1.43(95%CI：1.10，1.86)。根据性别、年龄、吸烟和高血压进行分组，结果是一致的。结论：通过短胰岛素耐量试验测量的胰岛素抵抗，而不是高胰岛素血症，与2型糖尿病患者的颈动脉粥样硬化独立相关。(C)2008爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: Insulin resistance may provide a crucial link between type 2 diabetes and cardiovascular disease. However, it is still unclear whether insulin resistance itself or hyperinsulinemia is independently associated with subclinical atherosclerosis. We hypothesized that insulin resistance, but not hyperinsulinemia, would be associated with carotid atherosclerosis in patients with type 2 diabetes.Methods: We examined 2471 patients with type 2 diabetes, consecutively enrolled in Hull Diabetes Center. Insulin sensitivity was directly assessed by a rate constant for plasma glucose disappearance (Kitt) using short insulin tolerance test. Fasting insulin levels were used as a marker of hyperinsulinemia. Both carotid arteries were examined by B-mode ultrasound. Carotid atherosclerosis was defined by having a clearly isolated focal plaque or mean carotid intima-media thickness (IMT) >= 1.1 mm.Results: In multiple regression models, insulin sensitivity index (Kitt) but not hyperinsulinemia was significantly associated with carotid IMT adjusting for known risk factors such as age, sex, BMI, smoking, systolic pressure, HDL and LDL cholesterol. One standard deviation decrease in Kitt was associated with 0.046 mm increase in carotid IMT (p = 0.015). Furthermore, odds ratio for carotid atherosclerosis was 1.43 (95% Cl: 1.10, 1.86) in type 2 diabetic patients with insulin resistance (lowest quartile of insulin sensitivity) adjusting for known risk factors. The results were consistent in all Subgroups stratified by sex, age, smoking and hypertension.Conclusion: Insulin resistance measured by short insulin tolerance test, but not hyperinsulinemia, is independently associated with carotid atherosclerosis in patients with type 2 diabetes. (C) 2008 Elsevier Ireland Ltd. All rights reserved.