Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects -: Implications for preventing coronary heart disease during the prediabetic state
Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects -: Implications for preventing coronary heart disease during the prediabetic state
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DOI：
10.1161/01.cir.101.9.975
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发表时间：
2000-03-07
期刊：
影响因子：
37.8
通讯作者：
Stern, MP
中科院分区：
文献类型：
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作者：
Haffner, SM;Mykkänen, L;Stern, MP
背景：与非转换者相比，转换为2型糖尿病的受试者心血管危险因素增加。尚不清楚糖尿病前期状态下的这些致动脉粥样硬化的变化是否主要是由于胰岛素抵抗、胰岛素分泌减少或两者。方法和结果-我们在圣安东尼奥心脏研究的7年随访中检查了这个问题，在该研究中，1734名受试者中有195名转化为2型糖尿病。在基线时，转换者的体重指数、腰围、甘油三酯浓度和血压明显高于非转换者，而HDL胆固醇则低于非转换者。转换器中的动脉粥样硬化变化明显减弱在调整胰岛素抵抗的稳态模型评估后（且不再显著）（HOMA IR，胰岛素抵抗的替代品）;与此相反，在调整早期胰岛素增量与早期葡萄糖增量的比值后，转换者和非转换者之间的危险因素差异增加（Δ I-30.0/Δ G（30.0））。我们还比较了具有主要胰岛素抵抗（高HOMA IR和高Δ I-30.0/G（30.0））的转换者（n=56）和具有主要胰岛素分泌减少（低HOMA IR和低Δ I-30.0/Δ G（30.0））的转换者（n = 31）与非转换者（n = 1539）。只有转换器谁是胰岛素抵抗有较高的血压和甘油三酯水平和较低的HDL胆固醇水平比nonconverters. Conclusions，我们的数据表明，动脉粥样硬化的变化，糖尿病前期状态主要是在胰岛素抵抗的主题，预防2型糖尿病的策略可能会集中在胰岛素增敏干预措施，而不是干预措施，增加胰岛素分泌，因为对心血管疾病的风险的潜在影响。
Background-Subjects who convert to type 2 diabetes mellitus have increased cardiovascular risk factors relative to nonconverters, However. it is not known whether these atherogenic changes in the prediabetic state are predominantly due to insulin resistance, decreased insulin secretion, or both.Methods and Results-We examined this issue in the 7-year follow-up of the San Antonio Heart Study, in which 195 of 1734 subjects converted to type 2 diabetes. At baseline, converters had significantly higher body mass index, waist circumference, triglyceride concentration, and blood pressure and lower HDL cholesterol than nonconverters. Atherogenic changes in converters were markedly attenuated (and no longer significant) after adjustment for the homeostasis model assessment of insulin resistance (HOMA IR, a surrogate for insulin resistance); in contrast, the differences in risk factors between converters and nonconverters increased after adjustment for the ratio of early insulin increment to early glucose increment (Delta I-30.0/Delta G(30.0)) during an oral glucose tolerance test (a surrogate for insulin secretion). We also compared converters who had a predominant insulin resistance (high HOMA IR and high Delta I-30.0/G(30.0)) (n=56) and converters who had a predominant decrease in insulin secretion (low HOMA IR and low Delta I-30.0/Delta G(30.0)) (n = 31) with nonconverters (n = 1539). Only the converters who were insulin resistant had higher blood pressure and triglyceride levels and lower HDL cholesterol levels than nonconverters.Conclusions-Our data suggest that atherogenic changes in the prediabetic state are mainly seen in insulin-resistant subjects and that strategies to prevent type 2 diabetes might focus on insulin-sensitizing interventions rather than interventions that increase insulin secretion because of potential effects on cardiovascular risk.