Cross-sectional and Longitudinal Analyses of Factors Contributing to the Progressive Loss of the β-cell Function in Type 2 Diabetes
Cross-sectional and Longitudinal Analyses of Factors Contributing to the Progressive Loss of the β-cell Function in Type 2 Diabetes
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DOI：
10.2169/internalmedicine.54.4351
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发表时间：
2015-01-01
影响因子：
1.2
通讯作者：
Yamada, Kentaro
中科院分区：
文献类型：
--
作者：
Nakayama, Hitomi;Kato, Tomoko;Yamada, Kentaro
目的2型糖尿病是一种以胰岛素抵抗和胰岛素分泌功能障碍为特征的进行性疾病。在这项研究中，我们评估了导致2型糖尿病患者胰岛素分泌缺陷的因素。方法选取382例2型糖尿病患者，年龄57+/-13岁。我们使用6分钟后胰高血糖素c肽增量（Delta CPR）来估计β细胞功能。结果糖尿病诊断时间与Delta心肺复苏术时间呈显著负相关。简单线性回归分析表明，δ CPR以0.056 ng/mL/年的速度下降。根据多元回归模型，体重指数（BMI）和log（甘油三酯）与Delta CPR呈正相关。糖尿病诊断时间、一级亲属糖尿病、是否存在糖尿病视网膜病变、HbA1c与Delta CPR呈负相关。在50例接受两次胰高血糖素刺激试验的患者中，Delta CPR在6.5+/-0.9年的时间内从2.27+/-1.47降至1.72+/-1.08 ng/mL。多元回归分析显示BMI和空腹血糖水平是Delta CPR下降的重要因素。结论糖尿病病程、低BMI、遗传因素和微血管病变可能与糖尿病患者β细胞功能障碍有关。本研究的观察结果表明，尽管最初的心肺复苏术反应很高，但肥胖受试者的β细胞功能迅速下降。导致胰岛素抵抗和糖毒性的环境因素因此可能与进行性β细胞衰竭有关。
Objective Type 2 diabetes is a progressive disease characterized by insulin resistance and insulin secretory dysfunction. In this study, we assessed the factors contributing to an insulin secretory defect in type 2 diabetes patients.Methods The subjects consisted of 382 patients with type 2 diabetes, aged 57+/-13 years. We estimated the beta-cell function using 6-min post-glucagon increments in C-peptide (Delta CPR).Results A significant inverse correlation was observed between the time since the diagnosis of diabetes and Delta CPR. A simple liner regression analysis showed that Delta CPR decreases at a rate of 0.056 ng/mL/year. According to a multiple regression model, body mass index (BMI) and log (triglyceride) were positively correlated with Delta CPR. Time since the diagnosis of diabetes, diabetes in 1st degree relatives, the presence of diabetic retinopathy, and HbA1c were inversely correlated with Delta CPR. In 50 patients who underwent the glucagon stimulation test twice, the Delta CPR decreased from 2.27+/-1.47 to 1.72+/-1.08 ng/mL over a period of 6.5+/-0.9 years. A multiple regression analysis revealed the BMI and fasting plasma glucose level to be significant contributing factors to the decline in Delta CPR.Conclusion The duration of diabetes, a low BMI, genetic factors, and the presence of microangiopathy may be associated with beta-cell dysfunction in diabetic patients. The observations in this study suggest that obese subjects showed a rapid decline in the beta-cell function despite an initial high CPR response. Environmental factors causing insulin resistance and glucotoxicity may therefore be involved in progressive beta-cell failure.