Metabolic markers associated with insulin resistance predict type 2 diabetes in Koreans with normal blood pressure or prehypertension.
Metabolic markers associated with insulin resistance predict type 2 diabetes in Koreans with normal blood pressure or prehypertension.
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DOI：
10.1186/s12933-016-0368-7
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发表时间：
2016-03-22
影响因子：
9.3
通讯作者：
Reaven G
中科院分区：
文献类型：
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作者：
Sung KC;Park HY;Kim MJ;Reaven G
关于高血压和2型糖尿病(T2 DM)发病率增加之间的联系仍有疑问。这项分析的前提是，胰岛素抵抗/代偿性高胰岛素血症是T2 DM的主要预测因素，任何人群中胰岛素抵抗的患病率越高，无论是血压正常还是高血压，发生T2 DM的可能性就越大。需要检验的假设是，对胰岛素抵抗的替代估计将在很大程度上预测血压正常或高血压前期的人发生T2 DM。对2001年开始的一项基于人口的调查的数据进行了分析，调查对象为韩国农村和城市地区的10038名40岁的居民，其中包括基线和8年后的人口和新陈代谢特征。参与者被归类为血压正常或高血压前期，与T2 DM病理生理相关的三种简单胰岛素抵抗表现用于预测T2 DM的发生：(1)血糖(75 mg口服葡萄糖挑战后2小时的血糖浓度=2.2hPG)；(2)高胰岛素血症(75g口服葡萄糖挑战后2小时的胰岛素浓度=2.2hPI)；(3)血脂异常(空腹血浆甘油三酯/高密度脂蛋白胆固醇浓度的比率=1TG/高密度脂蛋白胆固醇浓度)。在2小时PG浓度最高的四分位数中，发生T2 DM的完全调整后的风险比(HR，95%CI)最高(P<0.001)，范围从高血压前期女性的5.84%(3.3710.1)到血压正常的男性的12.2%(7.1221.00)。在甘油三酯/高密度脂蛋白胆固醇比率最高的四分位数的受试者中，2型糖尿病的程度也明显更大，高血压前期女性的HR值从2.91%(1.63-2.58%)到高血压前期男性的1.77%(1.12%-2.81%)不等。预测胰岛素抵抗的最小指标是2小时的PI浓度。在2小时PI浓度的最高四分位数内血压正常的受试者与T2 DM的发生显著相关，男性和女性的HR值分别为1.5(1.02-2.20，P=0.001)和2.02(1.35-3.02，P<0.05)。最后，无论预测因素如何，在高血压前期患者中，T2 DM的发病率在最高四分位数中略高。在血压正常或高血压前期的患者中，与胰岛素抵抗相关的代谢变量(血糖、胰岛素和血脂异常)可预测T2 DM的发生。本文的在线版本(doi：10.1186/s12933-0160368-7)包含补充材料，授权用户可以使用。
Questions remain as to the association between essential hypertension and increased incidence of type 2 diabetes (T2DM). The premise of this analysis is that insulin resistance/compensatory hyperinsulinemia is a major predictor of T2DM, and the greater the prevalence of insulin resistance within any population, normotensive or hypertensive, the more likely T2DM will develop. The hypothesis to be tested is that surrogate estimates of insulin resistance will predict incident T2DM to a significant degree in persons with normal blood pressure or prehypertension. Analysis of data from a population-based survey of 10, 038 inhabitants of rural and urban areas of Korea, ≥40 years-old, initiated in 2001, with measures of demographic and metabolic characteristics at baseline and 8-years later. Participants were classified as having normal blood pressure or prehypertension, and three simple manifestations of insulin resistance related to the pathophysiology of T2DM used to predict incident T2DM: (1) glycemia (plasma glucose concentration 2-hour after 75 g oral glucose challenge = 2-hour PG); (2) hyperinsulinemia (plasma insulin concentration 2-hour after 75 g oral glucose challenge = 2-hour PI); and (3) dyslipidemia (ratio of fasting plasma triglyceride/high/density lipoprotein cholesterol concentration = TG/HDL-C ratio). Fully adjusted hazard ratios (HR, 95 % CI) for incident T2DM were highest (P < 0.001) in the quartile of individuals with the highest 2-hour PG concentrations, ranging from 5.84 (3.37–10.1) in women with prehypertension to 12.2 (7.12–21.00) in men with normal blood pressure. T2DM also developed to a significantly greater degree in subjects within the highest quartile of TG/HDL-C ratios, with HRs varying from 2.91 (1.63–2.58) in women with prehypertension (P < 0.001) to 1.77 (1.12–2.81, P < 0.05) in men with prehypertension. The least predictive index of insulin resistance was the 2-hour PI concentration. Subjects with normal blood pressure in the highest quartile of 2-hour PI concentrations were significantly associated with incident T2DM, with HRs of 1.5 (1.02–2.20, P = 0.25) and 2.02 (1.35–3.02, P < 0.001), in men and women, respectively. Finally, incidence of T2DM in the highest quartile was somewhat greater in patients with prehypertension, irrespective of predictor. Metabolic variables associated with insulin resistance (glycemia, insulinemia, and dyslipidemia) predict the development of T2DM in patients with either normal blood pressure or prehypertension. The online version of this article (doi:10.1186/s12933-016-0368-7) contains supplementary material, which is available to authorized users.