Insulin secretion and sensitivity as determinants of HbA1c in type 2 diabetes
Insulin secretion and sensitivity as determinants of HbA1c in type 2 diabetes
复制标题
DOI：
10.1111/j.1365-2362.2006.01623.x
复制
发表时间：
2006-04-01
影响因子：
5.5
通讯作者：
Lapinski, H
中科院分区：
文献类型：
--
作者：
Monnier, L;Colette, C;Lapinski, H
背景胰岛素分泌缺陷和敏感性缺陷是血糖控制的两个主要决定因素，可能会同时发生，也可能不同时发生。本研究旨在比较两种决定因素在2型糖尿病患者糖化血红蛋白(HbA1c)中的各自作用，根据是否被胰岛素分泌剂刺激残存的β细胞功能。材料与方法用稳态模型评估(HOMA)评估胰岛素分泌和胰岛素敏感性。测定289例非胰岛素依赖型2型糖尿病患者的糖化血红蛋白(HbA1c)、胰岛素敏感性(HOMA2%S)和胰岛素分泌(HOMA2%B)，并根据治疗分为二甲双胍(I组，n=57)和二甲双胍+格列本脲(II组，n=232)。结果两组患者HbA1c对HOMA2%B和HOMA2%S的依赖性分别为8.4%和8.4%，HOMA2%B和HOMA2%分别为7.2%和6.8%(P=0.0013)。在II组中，HbA1c和HbA1c=8%的两组患者刺激胰岛素分泌的平均值(HOMA2%B)分别为40.7%和30.1%，低于HbA1c和HbA1c=8%组的55.1%(P<；0.0001)。多元逐步回归分析显示，HOMA2%B对HbA1c的贡献在I组(33.5%比23.4%)和II组(22.7%比8%)中均高于HOMA2%B组(22.7%比8%)。结论尽管胰岛素敏感性的作用不可忽视，但胰岛素分泌似乎是显性2型糖尿病患者控制糖尿病的主要决定因素。
Background Defects in insulin secretion and sensitivity, two major determinants of glycaemic control, can occur and progress or not in parallel. The present study was designed to compare the respective roles of both determinants on HbA1c, in type 2 diabetic patients, according to whether or not residual beta-cell function was stimulated with insulin secretagogues.Materials and methods Insulin secretion and insulin sensitivity were both estimated using the homeostasis model assessment (HOMA). HbA1c, insulin sensitivity (HOMA2%S) and insulin secretion (HOMA2%B) were determined in 289 noninsulin-using type 2 diabetic patients who were further divided into two groups according to treatment: metformin alone (group I, n = 57) or metformin and glyburide (group II, n = 232). The patients of both groups were further divided into three subsets in order to test the dependence of HbA1c on HOMA2%B and HOMA2%S.Results In group I mean HbA1c were greater (8.4%) in patients with HOMA2%B < 50% than in the two subsets with HOMA2%B >= 50%: 7.2 and 6.8% (P = 0.0013). In group II mean values of stimulated-insulin secretion (HOMA2%B) were lesser (40.7 and 30.1%) in the two subsets of patients with HbA1c >= 8% than in patients with HbA1c < 8%: 55.1% (P < 0.0001). By contrast, we found no differences in both groups with HOMA2%S. A stepwise multiple regression showed that HOMA2%B contributed to HbA1c more than HOMA2%S both in groups I (33.5% vs. 23.4%) and II (22.7% vs. 8%).Conclusions Although the role of insulin sensitivity is not negligible, insulin secretion appears to be the major determinant of diabetic control in overt type 2 diabetic patients who are treated with metformin alone or with a two-drug therapy combining metformin and glyburide.